Strengths and limitations
blood loss
BLOOD LOSS, COMPLICATIONS
Our randomized controlled trial has several strengths. Ours is the first trial to compare the combination of tranexamic acid and ethamsylate with oxytocin and placebo, in which we provided a sufficient and reasonable assessment of our intervention groups. In addition, we recruited a relatively larger sample size than the previous studies which discussed the same issue. Moreover, the present study adequately addressed fetal outcomes to assess the safety profile of tranexamic acid together with ethamsylate compared to oxytocin and saline. On the other hand, this study has some limitations; involving the limitation of long-term follow-up to assess the complications of severe maternal blood loss. Moreover, there were differences between the three groups regarding parity, types of CS, indications of CS, and previous CS which made us perform an adjustment analysis according to these variables as they could affect the results. Moreover, other clinical trials are needed to support our findings. In addition, our study included both elective and emergency CS; however, the number of emergency cases was very small (six patients). The results can be affected according to this factor, therefore, studies comparing the effect of these drugs on both emergency and elective CS cases are needed.