Tranexamic acid in prevention of postpartum hemorrhage in elective cesarean section


  • Pravin Shah Department of Obstetrics and Gynecology, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
  • Ajay Agrawal Department of Obstetrics and Gynecology, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
  • Shailaja Chhetri Department of Obstetrics and Gynecology, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
  • Pappu Rijal Department of Obstetrics and Gynecology, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
  • Nisha K. Bhatta Department of Pediatrics and Adolescent Medicine, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal



Cesarean section, Postpartum hemorrhage, Tranexamic acid


Background: Postpartum hemorrhage is a common and occasionally life-threatening complication of labor. Cesarean section is associated with more blood loss in compared to vaginal delivery. Despite, there is a trend for increasing cesarean section rates in both developed and developing countries thereby increasing the risk of morbidity and mortality, especially among anemic women. The objective of this study was to evaluate the effect of preoperative administration of intravenous Tranexamic acid on blood loss during and after elective cesarean section.

Methods: This was a prospective, randomized controlled study with 160 eligible pregnant women of 37 or more period of gestation. They were all planned for elective cesarean section and were randomized into two groups either to receive 10ml (1gm) of Tranexamic acid intravenously or 10ml of normal saline. Blood loss was measured during and for 24 hours after operation.

Results: The mean estimated blood loss was significantly lower in women treated with Tranexamic acid compared with women in the placebo group (392.13 ml±10.06 vs 498.69 ml±15.87, respectively; p<0.001). The mean difference in pre-operative and post-operative hemoglobin levels was statistically significant in the Tranexamic acid group than in the control group (0.31±0.18 vs 0.79±0.23, respectively; p<0.001).

Conclusions: Pre-operative use of Tranexamic acid is associated with reduced blood loss during and after elective cesarean section. In a developing country like ours where postpartum hemorrhage is a major threat to the life of the mothers, it seems to be a promising option.


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