Efficacy of tranexamic acid in preventing postpartum haemorrhage in vaginal delivery


  • G. Anantha Lakshmi Satyavathi Department of Obstetrics and Gynecology, GSL Medical College and General Hospital, Rajahmundry, Andhra Pradesh, India
  • Chandrika K. Department of Obstetrics and Gynecology, GSL Medical College and General Hospital, Rajahmundry, Andhra Pradesh, India




Blood loose, Oxytocin, Postpartum haemorrhage, Third stage labour, Tranexamic acid, Vaginal delivery


Background: Postpartum blood loss is difficult to evaluate especially in developing countries like India where most of the women are anaemic with poor reserve and these conditions are further aggravated by increased demand during pregnancy and blood loss during third stage of labour. The present study was planned to compare the efficacy of prophylactic 10 IU intramuscular oxytocin and 10 IU intramuscular oxytocin +1g Tranexamic acid in reducing blood loss in the third stage of labour.

Methods: The present study was carried out on full term pregnancies primigravida/ multiparas with singleton pregnancy being delivered vaginally at GSL Hospital, Rajahmundry between 2016-2017 were included. For this comparative study, 200 women in labor were included after obtaining informed consent. A detailed obstetric history, history of previous medical illnesses, history of the treatment received earlier, cardiovascular and respiratory system and other systems including thyroid and breast were noted.

Results: The average total blood loss in IIIrd stage of labour with IM oxytocin was 210 ml and with IM oxytocin + Tranexamic acid was130 ml, which was statistically significant (p<0.001). Oxytocin + Tranexamic acid group had less blood loss when compared to oxytocin group alone. Side effects like, nausea vomiting, headache were slightly more with oxytocin + Tranexamic acid group when compared to oxytocin group alone.

Conclusions: In the active management of IIIrd stage of labour 10 IU intramuscular Oxytocin + one gram of tranexamic acid IV is a better combination in reducing the blood loss at delivery when compared to 10 IU intramuscular oxytocin alone.


Smith JR, Brennan BG. Postpartum hemorrhage. E Medicine. 2006;13:1-9.

Pattinson RC. Overview-third report on confidential enquiries into maternal deaths in South Africa 2002-2004: overview. In Obstetrics Gynaecology Forum 2006;16(3):79-82.

Ferrazzani S, Guariglia L, Draisci G, Sorrentino L, De Stefano V, D'Onofrio G, et al. Postpartum hemorrhage. Minerva Gynecol. 2005;57(2):111-29.

Obstet IJ. Diagnosis and management of postpartum hemorrhage. Int J Gynecol Obstet. 1991;36:159-63.

Deneux-Tharaux C, Sentilhes L, Maillard F, Closset E, Vardon D, Lepercq J, et al. Effect of routine controlled cord traction as part of the active management of the third stage of labour on postpartum haemorrhage: multicentre randomised controlled trial (TRACOR). BMJ. 2013;346:f1541.

Soltani H, Hutchon DR, Poulose TA. Timing of prophylactic uterotonics for the third stage of labour after vaginal birth. Cochrane Database of Systematic Reviews. 2010(8).

Meiser A, Casagranda o, Skipka G, Laubenthal M. quantification of blood loss. How precise is visual estimation and what does its accuracy depend on? Anaesthetist. 2001;50:13-20.

Didly GA, paine AR, George NC, Velasco C. Estimating blood loss: can teaching significantly improve visual estimation? Obstet Gynecol. 2004;104:601-6.

Gatch WD, Little WD. Amount of blood lost during some of the more common operations: preliminary report. J Am Med Assoc. 1924;83(14):1075-6.

Coller FA, Campbell KN, Vaughan HH, Iob LV, Moyer CA. Postoperative salt intolerance. Ann Surg. 1944;119(4):533.

Murdoch JM, Campbell GD. Antithyroid Activity of N-Phthalyl Glutamic Acid Imide (K17). Br Med J. 1958;1(5062):84.

Brant HA. Blood loss at caesarean section. BJOG: Int J Obstet Gynaecol. 1966;73(3):456-9.

O'Driscoll K, McCarthy JR. Abruptio placentae and central venous pressures. BJOG. 1966;73(6):923-9.

Roy P, Sujatha MS, Bhandiwad A, Biswas B, Chatterjee A. Placental blood drainage as a part of active management of third stage of labour after spontaneous vaginal delivery. J Obstet Gynecol India. 2016;66(1):242-5.

Ferrer P, Roberts I, Sydenham E, Blackhall K, Shakur H. Anti-fibrinolytic agents in post partum haemorrhage: a systematic review. BMC pregnancy and childbirth. 2009;9(1):29.

Yang H, Zheng S, Shi C. Clinical study on the efficiency of tranexamic acid in reducing postpartum blood loss - a randomized multicentre trial. Zhonghua Fu Chan Zazhi. 2001;36(10):590-2.

Gungorduk K, Yildirim G, Ascioglu O, Gungorduk OC, Sudolmus S, Ark C. Efficacy of intravenous tranexamic acid in reducing blood loss after elective caesarean section: a prospective, randomized, double blind, placebo controlled study. Am J Perinatol. 2011;28:233-40.

Gai MY, Wu LF, Su QF. Clinical observation of blood loss reduced by tranexamic acid during and after caesarean section: a multicentre randomized trial. Eur J Obste Gynaecol Reprod Biol. 2004;112(2):154-7.

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

Gulmezogulu AM, Lumbiganon P, Landousi S, Widmer M, Abdel-Aleem H, Festin M, et al. Active management of the third stage of labour with and without controlled cord traction: a randomized, controlled, non-inferiority trial. Lancet. 2012;379:1721-7.






Original Research Articles