Published: 2022-10-28

Effect of prophylactic tranexamic acid in normal vaginal delivery

Vishakha Gupta, Alka Sehgal, Rimpy Tandon, Dilpreet Kaur Pandher, Anita Tahlan


Background: Use of tranexamic acid (TXA) in combination with uterotonics in management of postpartum haemorrhage is quite established, but its use for prophylaxis is still uncommon, specifically post normal delivery. Shock index (SI) (heart rate divided by systolic blood pressure) and delta shock index (DSI) i.e., difference of SI before and after an event are being recognized as tools for hemodynamic status evaluation and bedside assessment for individual respectively. The present study compared the combined effect of TXA and oxytocin uterotonic on postpartum blood loss as evaluated by shock index (SI) and delta shock index (DSI) in low-risk pregnancies.

Methods: 230 subjects divided equally, underwent randomised control trial with combination of Injection TXA and oxytocin versus oxytocin alone immediately post-delivery and impact evaluated using SI, DSI, postpartum haemoglobin (HB) and haematocrit (HCT) at admission and one hour postpartum, followed for six weeks for any complications.

Results: Prophylactic use of TXA in terms of SI values, HB and HCT revealed significant improvement, in both preterm and term pregnancies with either spontaneous or induced labours. DSI with a sensitivity of 69.6% and specificity of 67% with a simple plus or minus notation gave a satisfactory idea of shift of stability and instability of hemodynamic status of an individual as an indirect predictor of blood loss with a cut-off between -0.0682 to +0.1182. 6 weeks postpartum follow up was uneventful.

Conclusions: The study depicted benefit and safety profile of prophylactic use of TXA in low-risk pregnancies, significant for developing countries with high incidence of anaemia during pregnancy and advocates incorporation of SI and DSI as markers of haemodynamic status in partograph.


Postpartum haemorrhage, Pregnancy, Shock, Tranexamic acid

Full Text:



Leduc D, Senikas V, Lalonde A, Leduc D, Ballerman C, Biringer A, et al. Active Management of the Third Stage of Labour: Prevention and Treatment of Postpartum Hemorrhage. J Obstet Gynaecol Can. 2009;31:980-93.

Mielke R, Obermeyer S. The use of tranexamic acid to prevent postpartum hemorrhage. J Midwife Women Health. 2020;65.

Pacagnella RC, Souza JP, Durocher J, Perel P, Blum J, Winikoff B, et al. A systematic review of the relationship between blood loss and clinical signs. PLoS One. 2013;8:e57594.

Nathan HL, Cottam K, Hezelgrave NL, Seed PT, Briley A, Bewley S, et al. Determination of normal ranges of shock index and other haemodynamic variables in the immediate postpartum period: a cohort study. PLoS One. 2016;11:e0168535.

Kohn JR, Dildy A, Eppes CS. Shock index and delta-shock index are superior to existing maternal early warning criteria to identify postpartum hemorrhage and need for intervention. J Matern Fet Neonat Med 2019;32:1238-44.

Sentilhes L, Daniel V, Deneux-Tharaux C. TRAAP2- tranexamic acid for preventing postpartum hemorrhage after cesarean delivery: a multicenter randomized, double-blind, placebo-controlled trial- a study protocol. BMC Pregnancy Childbirth. 2020;20:1.

Yang H, Zheng S, Shi C. Clinical study on the efficacy of tranexamic acid in reducing postpartum blood loss: a randomized, comparative, multicenter trial. Zhonghua Fu Chan Ke Za Zhi. 2001;36:590-2.

Sentilhes L, Winer N, Azria E, SeĢnat MV, Le Ray C, Vardon D, et al. Tranexamic Acid for the Prevention of Blood Loss after Vaginal Delivery. N Engl J Med. 2018;379:731-42.

Roy P, Sujatha MS, Bhandiwad A, Biswas B. Role of tranexamic acid in reducing blood loss in vaginal delivery. J Obstet Gynecol India. 2016;66:246-50.

Nathan HL, El Ayadi A, Hezelgrave NL, Seed P, Butrick E, Miller S, et al. Shock index: an effective predictor of outcome in postpartum haemorrhage. BJOG: Int J Gynaecol Obstet. 2015;122:268-75.

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.