Published: 2022-01-28

Safety and effectiveness of tranexamic acid in reduction of post-partum hemorrhage in patients undergoing caesarean section in tertiary care hospital of Southern India

Girish B. L., Shraddha S. G., Dwarakanath L.


Background: Obstetric haemorrhage is a leading cause of premature maternal mortality, accounting for at least 100,000 deaths each year worldwide. Tranexamic acid has been shown to reduce uterine blood loss in non-surgical aspect. The aim of the study is to evaluate the safety and effectiveness of TXA in prevention of post-partum hemorrhage in patients undergoing caesarean delivery and to compare the secondary clinical outcomes.

Methods: In this prospective observational cross-sectional study, 50 pregnant women undergoing CD were selected in random pattern and divided into control and study group of 25 patients each, in the department of obstetrics and gynaecology in Sri. Siddhartha medical college, Tumakuru from November 2019 to October 2021. The study group were given 1 g of TXA intravenously and the control group did not receive TXA. All the pregnant women received 20 units of oxytocin following delivery.

Results: Mean of the total blood loss in the study group was 67 % less than the control group. Secondary clinical outcomes such as need for blood transfusion, other surgical measures to stop bleeding were comparatively less in study group compared to control groups. To note, no significant difference in duration of hospital stay was found between two groups.

Conclusions: Our study suggests that, a safe dose of 1g IV tranexamic acid prior to caesarean section has an effective role in reducing blood loss and significantly improved blood loss–related secondary clinical outcomes with fewer side effects.



Caesarean section, Tranexamic acid, Post-partum hemorrhage

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Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2014; 2:e323-33.

Al-Zirqi I, Vangen S, Forsen L, Stray-Pedersen B. Effects of onset of labor and mode of delivery on severe postpartum hemorrhage. Am J Obstet Gynecol. 2009;201:273 e1-9.

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.

Callaghan WM, Kuklina EV, Berg CJ. Trends in postpartum hemorrhage: United States, 1994–2006. Am J Obstet Gynecol. 2010;202:353 e1-6.

Perel P, Ker K, Morales Uribe CH, Roberts I. Tranexamic acid for reducing mortality in emergency and urgent surgery. Cochrane Database Syst Rev. 2013;1:CD010245.

WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet. 2017;389:2105-16.

CRASH-2 trial collaborators. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010;376:23-32.

Sahu J, Mishra N. Role of intravenous tranexamic acid in reducing blood loss during caesarean section: Study at tribal dominated area hospital in Chhattisgarh, India. J Obstet Gynaecol Res. 2019; 45(4):841-8.

Nivedhana AP, Indu NR, Jalakandan B. Does prophylactic tranexamic acid reduce blood loss in Indian women following vaginal delivery?. Int J Reprod Contracept Obstet Gynecol. 2021;10:497-504.

Gohel M, Patel P, Gupta A, Desai P. Efficacy of tranexamic acid in decreasing blood loss during and after cesarean section: A randomized case controlled prospective study. J Obstet Gynecol India. 2007; 57(3):227-30.

Bhatia SK, Deshpande H. Role of tranexamic acid in reducing blood loss during and after caesarean section. Med J DY Patil Univ. 2015;8:21-5.

Naganagoudaru R, Vinaya G. Tranexamic acid for the treatment of postpartum hemorrhage: placebo controlled study. Int J Reprod Contracept Obstet Gynecol. 2017;6:3071-5.

Yehia A, Koleib M, Abdelazim I, Atik A. Tranexamic acid reduces blood loss during and after cesarean section: A double blinded, randomized, controlled trial. Asian Pacific J Reprod. 2014;3(1):53-6.

Novikova N, Hofmeyr GJ, Cluver C. Tranexamic acid for preventing postpartum haemorrhage. Cochrane Database Syst Rev. 2015;(6):CD007872.

Alam A, Choi S. Prophylactic use of tranexamic acid for postpartum bleeding outcomes: a systematic review and meta-analysis of randomized controlled trials. Transfus Med Rev. 2015;29:231-41.

Simonazzi G, Bisulli M, Saccone G, Moro E, Marshall A, Berghella V. Tranexamic acid for preventing postpartum blood loss after cesarean delivery: a systematic review and meta-analysis of randomized controlled trials. Acta Obstet Gynecol Scand. 2016;95:28-37.

Li C, Gong Y, Dong L, Xie B, Dai Z. Is prophylactic tranexamic acid administration effective and safe for postpartum hemorrhage prevention? A systematic review and meta-analysis. Medicine (Baltimore). 2017;96(1):e5653.

Sivakumar H, Peyton PJ. Poor agreement in significant findings between meta-analyses and subsequent large randomized trials in perioperative medicine. Br J Anaesth. 2016;117:431-41.

Sentilhes L, Winer N, Azria E, Sénat MV, Le Ray C, Vardon D. Tranexamic acid for the prevention of blood loss after vaginal delivery. N Engl J Med. 2018;379(8):731-42.

Satyavathi GAL, Chandrika K. Efficacy of tranexamic acid in preventing postpartum haemorrhage in vaginal delivery. Int J Reprod Contracept Obstet Gynecol. 2019;8(9):1-7.