Post Partum Hemorrhage

Fibrinolysis; Hemorrhage

Blood Loss

Two doses of Tranexamic Acid (1 gram), diluted in 100 cc of normal saline. Administered intravenously at least 10 minutes prior to skin incision and repeated immediately after placental delivery.

Tranexamic Acid

100 mL of normal saline. Administered intravenously at least 10 minutes prior to skin incision and repeated immediately after placental delivery.

Placebo

Parkland Hospital

Tranexamic Acid for Prevention of Hemorrhage in Cesarean Delivery

Use of Tranexamic Acid for Prevention of Hemorrhage in Cesarean Delivery

Total blood volume lost will be calculated in milliliters.

Olutoyosi Ogunkua

Associate Professor of Medicine

University of Texas Southwestern Medical Center

Patients randomized to the aggressive intravenous hydration group receive lactated ringers (LR) IV at 3 mL kg-1 hr-1 during the procedure, a 20cc/kg LR IV bolus immediately afterward, and LR IV at 3 mL kg-1 hr-1 for 8 hours following the procedure.

Those in the control arm receive standard fluids defined as LR at 1.5 mL kg-1 hr-1 during the procedure and for 8 hours afterwards.

Pancreatitis

Patients in the intravenous hydration group wll be treated with lactated ringer infusion at a rate of 3cc/kg/hour during the procedure, be given a bolus of 20cc/kg immediately afterward and receive an infusion of 3cc/kg/hour for 8 hours after the procedure.

Aggressive Intravenous Hydration Group

Patients randomized to the standard fluids arm will receive lactated ringers at an infusion rate of 1.5cc/kg/hour during the procedure, will receive no bolus, and will receive an infusion of lactated ringers at 1.5cc/kg for 8 hours after the procedure.

Standard Fluids Arm

Los Angeles County Hospital

Randomized Trial of Aggressive Fluid Hydration to Prevent Post ERCP Pancreatitis

Feasibility Study of a Randomized Trial of Aggressive Fluid Hydration to Prevent Post ERCP Pancreatitis

The primary endpoint is post ERCP pancreatitis which is defined as increased abdominal pain and a serum amylase level three times the upper limit of normal (3xULN). Increased pain will be defined as an increase in the visual analog pain score compared to the value immediately prior to ERCP

Clinical volume overload will be defined by physical findings of lower extremity edema and pulmonary rales.

Serum amylase three times the upper limit of normal is a secondary outcome measure.

Increased abdominal pain is defined as an increase in abdominal pain based on the visual analogue score following the ERCP compared to the score immediately prior to the ERCP.

hypovolemia/protease

Tranexamic Acid for Prevention of Hemorrhage in Cesarean Delivery

Randomized Trial of Aggressive Fluid Hydration to Prevent Post ERCP Pancreatitis

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