Effect of tranexamic acid in prevention of postpartum hemorrhage in elective caesarean delivery: a randomized controlled study

Abd El-Naser Abd El-Gaber, Hazem H. Ahmed, Mustafa M. Khodry, Ahmed M. Abbas


Background: Postpartum hemorrhage is the ugly ghost that most obstetricians believe because many cases unpredicted and may be associated with rapid patient deterioration that may lead mortality or developing serious long-term morbidities. The objective of this study is to assess the efficacy of slowly intravenous administration of tranexamic acid in prevention and decline the severity of postpartum hemorrhage immediately prior to elective caesarean section.

Methods: A double blinded, randomized, case control trial carried out at Obstetrics and Gynecology Department, Faculty of Medicine, South Valley University, Egypt from May 2017 to April 2018. This study was conducted on 500 full term pregnant women underwent elective caesarean section. The patients were divided randomly into: Group A (study group) included 250 patients received tranexamic acid 1gm slowly iv over 2 minutes at least 10 minutes before operation started and Group B (control group) included 250 patients that received placebo (normal saline NaCl 0.9%).

Results: Incidence of PPH in group A and group B were (4.4% and 6.8) respectively, 1.2% in group A and 2.8% in group B had severe degree of PPH. Amount of blood loss immediately after placental delivery up to first 6 hours postoperative was statistically significant increase in placebo group than tranexamic acid group with p value <0.001.

Conclusions: Tranexamic acid administration few minutes prior to elective cesarean section was effective in reducing the incidence and severity of PPH and decreased the use of additional uterotonic drugs and additional surgical interventions.


Elective cesarean delivery, Postpartum hemorrhage, Tranexamic acid

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Carroli G, Cuesta C, Abalos E, Gulmezoglu AM. Epidemiology of postpartum haemorrhage: a systematic review. Best Pract Res Clin Obstet Gynecol. 2008;22:999e1012.

Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Global Health. 2014;2(6):e323-33.

Menard MK, Main EK, Currigan SM. Executive summary of the revitalize initiative: standardizing obstetric data definitions. Obstet Gynecol 2014;124:150-3.

Dahlke JD, Mendez-Figueroa H, Maggio L, Hauspurg AK, Sperling JD, Chauhan SP, et al. Prevention and management of postpartum hemorrhage: a comparison of 4 national guidelines. Am J Obstet Gynecol 2015;213:76.e1-10.

Anderson JM, Etches D. Prevention and management of postpartum hemorrhage. Am Fam Physician. 2007;75:875e82.

Sheldon WR, Blum J, Vogel JP, Souza JP, Gülmezoglu AM, Winikoff B. WHO multicounty survey on maternal and newborn health research network. postpartum hemorrhage management, risks, and maternal outcomes: findings from the World Health Organization Multicounty Survey on Maternal and Newborn Health. BJOG. 2014;121:S5e13.

Leduc, Leduc D, Senikas V, Lalonde AB, Ballerman C, Biringer A, et al. Active management of the third stage of labor: prevention and treatment of postpartum hemorrhage. J Obstet Gynaecol Canada JOGC. 2009;31(10):980-93.

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

CRASH-2 Trial Collaborators, Shakur H, Roberts I, Bautista R, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant hemorrhage (CRASH-2): a randomized, placebo-controlled trial. Lancet. 2010;37 (9734):23-32.

Roberts I, Kawahara T, 18th Expert Committee on the Selection and Use of Essential Medicines, World Health Organization. Proposal for the inclusion of tranexamic acid (anti-fibrinolytic–lysine analogue) in the WHO model list of essential medicines. Available at: medicines/committees/expert/18/applications/TRANEXAMIC_ ACID_10_2.pdf?ua=1.

Othman ER, Fayez MF, El Aal DE, Mohamed HS, Abbas AM, Ali MK. Sublingual misoprostol versus intravenous oxytocin in reducing bleeding during and after cesarean delivery: A randomized clinical trial. Taiw J Obstet Gynecol. 2016;55(6):791-5.

Sentilhes L, Lasocki S, Ducloy-Bouthors AS, Deruelle P, Dreyfus M, Perrotin F, et al. Tranexamic acid for the prevention and treatment of postpartum haemorrhage. Br J Anaesth. 2015;114:576-87.

Abbas AM, Amin MT, Ali SS, Salem NZ. Maternal mortality: a tertiary care hospital experience in Upper Egypt. Int J Reprod Contracept Obstet Gynecol. 2017;5(5):1466-71.

WHO and World Bank, Trends in Maternal Mortality: 1990 to 2013. Estimates by WHO, UNICEF, UNFPA, Geneva: WHO, 2014.

El-Zanaty F, Way A. Egypt Demographic and Health Survey 2008, Cairo, Egypt: Ministry of Health, El-Zanaty, and Associates and Macro International, 2009.

Amin TT. Maternal and perinatal mortality: a snapshot on the Egyptian situation. Int Pub Heal Forum. 2014;1(3):1-5.

Campbell O, Gipson R, Issa AH, Matta N, El Deeb B, El Mohandes A, et al. National maternal mortality ratio in Egypt halved between 1992-93 and 2000. Bulletin of the World Health Organization. 2005;83:462-71.

Gai MY, Wu LF, Su QF, Tatsumoto K. Clinical observation of blood loss reduced by tranexamic acid during and after caesarian section: a multicenter randomized trial. Eur J Obstet Gynecol Reprod Biol. 2004;112:154-7.

Sekhavat L, Tabatabaii A, Dalili M, Farajkhoda T, Tafti AD. Efficacy of tranexamic acid in reducing blood loss after caesarean section. J Matern Fetal Neonatal Med. 2009;22:72-5.

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(1):28-37.

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

Ahmed MR, Sayed Ahmed WA, Madny EH, Arafa AM, Said MM. Efficacy of tranexamic acid in decreasing blood loss in elective caesarean delivery. J Matern Fetal Neonatal Med. 2015; 28:1014-8.

Walzman M, Bonnar J. Effect of tranexamic acid on the coagulation and fibrinolytic systems in pregnancy complicated by placental bleeding. Arch Toxicol Suppl. 1982;5:214-20.