Published: 2021-12-28

Efficacy of prophylactic tranexamic acid administration in prevention of postpartum hemorrhage in placenta previa cesarean section: an interventional study

Monika Rathore, Anjali Gupta, Nidhi Kumari


Background: Postpartum hemorrhage accounts for the major part of the mortality as well as morbidity like severe anemia, need for blood transfusion, hospital stay and infection. Aim and objectives of the study were to determine the efficacy and safety of prophylactic tranexamic acid and intravenous tranexamic acid in preventing postpartum hemorrhage in women undergoing caesarean section for placenta previa.

Methods: Seventy women with placenta previa over 1 year, randomized into 2 groups: group 1 (n=35): Women who received 10 IU oxytocin intravenous infusion after placental delivery and group 2 (n=35): Women who received 1 gm (10 ml) tranexamic acid IV before skin incision plus 10 IU oxytocin intravenous infusion after placental delivery.

Results: The mean age was similar in 2 groups i.e., 26.34±4.78 years in group 1 and 27.31±5.62 years in group 2. Most women in the present study presented with type IV placenta previa i.e., 34.3% in group 1 and 48.6% in group 2. Mean pre-operative hemoglobin was 9.57±1.54 g/dl in group 1 and 9.59±1.35 g/dl in group 2. Intra-operative mean blood loss was 729.31±172.45 ml in intravenous oxytocin group and 464.86±28.00 ml in intravenous tranexamic acid group. A total of 74.3% women in group 1 and 20% women in group 2 developed postpartum hemorrhage. Mean post-operative hemoglobin was 8.04±1.34 g/dl in group 1 and 8.85±1.26 g/dl in group 2. In group 1, 5.7% neonates were born with very low birth weight and while none in group 2. 51.4% neonates in group 1 and 45.7% in group 2 had low birth weight.

Conclusions: It is concluded that tranexamic acid used prophylactically intravenously before skin incision in patients undergoing cesarean section for placenta previa significantly reduces intra-operative blood loss. 


Prophylactic tranexamic acid, Postpartum hemorrhage, Placenta previa, Cesarean section

Full Text:



Prata N, Gerdts C. Measurement of postpartum blood loss. BMJ. 2010;340:c555.

Abou Zahr C. Global burden of maternal death and disability. Br Med Bull. 2003;67:1.

Kambo I, Bedi N, Dhillon BS, Saxena NC. A critical appraisal of cesarean section rates at teaching hospitals in India. Int J Gynecol Obstet. 2002;79:151-8.

Magann EF, Evans S, Hutchinson M, Collins R, Lanneau G, Morrison JC. Postpartum hemorrhage after cesarean delivery: an analysis of risk factors. South Med J. 2005;98:681-6.

Kramer MS, Berg C, Abenhaim H, Dahhou M, Rouleau J, Mehrabadi A et al. Incidence, risk factors, and temporal trends in severe postpartum hemorrhage. Am J Obstet Gynecol. 2013;209:449-e1.

Bateman BT, Berman MF, Riley LE, Leffert LR. The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries. Anesth Analg. 2010;110:1368-73.

Oppenheimer L. Society of obstetricians and Gynecologists of Canada. Diagnosis and management of placenta previa. J Obstet Gynecol Can. 2007;29:261-73.

Reddy UM, Abuhamad AZ, Levine D, Saade GR. Executive summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound fetal imaging workshop. Obstet Gynecol. 2014;123:1070-82.

Al-Harbi NA, Al-Abra ES, Alabbad NS. Utero-vaginal packing. Saudi Med J. 2009;30:243-6.

Frenzel D, Condous GS, Papageorghiou AT, McWhinney NA. The use of the ‘tamponade test to stop massive obstetric haemorrhage in placenta accreta. BJOG: Int J Obstet Gynecol. 2005;112:676-7.

B-Lynch C, Coker A, Lawal AH, Abu J, Cowen MJ. The B-Lynch surgical technique for the control of massive postpartum haemorrhage: an alternative to hysterectomy? Five cases reported. BJOG: Int J Obstet Gynecol. 1997;104:372-5.

Tjalma WA, Jacquemyn Y. Compression sutures instead of emergency peripartum hysterectomy. Eur J Obstet Gynecol Reprod Biol. 2005;118:258.

Clark SL, Phelan JP, Yeh SY, Bruce SR, Paul RH. Hypogastric artery ligation for obstetric hemorrhage. Obstet Gynecol. 1985;66:353-6.

WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomized, double-blind, placebo-controlled trial. Lancet. 2017;389:2105.

Shady NW, Sallam HF. Adjunctive IV tranexamic acid versus topical tranexamic acid application of the placental bed for prevention of postpartum hemorrhage in women with placenta previa: a randomized controlled trial. Int J Reprod Contracept Obstet Gynecol. 2017;6:5205-12.

Kaur K, Garg R, Kaur A, Jindal R. Feto-maternal outcome in placenta previa with unscarred uterus (one-year prospective study). Parity. 2018;36:2-62.

Sekiguchi A, Nakai A, Kawabata I, Hayashi M, Takeshita T. Type and location of placenta previa affect preterm delivery risk related to antepartum hemorrhage. Int J Med Sci. 2013;10:1683.

Salem MN, Mohamed MA, Salem AH, Abbas A. Tranexamic acid as prophylactic therapy for intra- and post-partum hemorrhage: randomized controlled trial. J Adv Med Med Res. 2016;17:1-7.

Lama S, Ranjit S. Study on maternal and immediate fetal outcome of placenta previa. Nepal J Obstet Gynecol. 2016;11:24-7.

Naik VR, Cardoso PM. A study of proportion, maternal and fetal outcomes in cases of placenta previa. IOSR-JDMS. 2018;17:1-5.

Yehia AH, Koleib MH, Abdelazim IA, Atik A. Tranexamic acid reduces blood loss during and after cesarean section: a double blinded, randomized, controlled trial. Asian Pac J Reprod. 2014;3:53-6.

Shahid A, Khan A. Tranexamic acid in decreasing blood loss during and after caesarean section. J Coll Physicians Surg Pak. 2013;23:459-62.

Sujata N, Tobin R, Kaur R, Aneja A, Khanna M, Hanjoora VM. Randomized controlled trial of tranexamic acid among parturients at increased risk for postpartum hemorrhage undergoing cesarean delivery. Int J Gynecol Obstet. 2016;133:312-5.

Xu J, Gao W, Ju Y. Tranexamic acid for the prevention of postpartum hemorrhage after cesarean section: a double-blind randomization trial. Arch Gynecol Obstet. 2013;287:463-8.

Roy I, Chakraborty S, Mukhopadhya S. Role of intravenous tranexamic acid on cesarean blood loss: a prospective randomized study. Trop J Obstet Gynecol. 2018;35:49-53.