The Use of Tranexamic Acid to Prevent Postpartum Hemorrhage.
Ruth T Mielke, Sarah Obermeyer
PMID 32431098WHAT IT FOUND
Prophylactic tranexamic acid is not established for preventing postpartum hemorrhage after vaginal birth.
One high-risk case used tranexamic acid, oxytocin, methergine, and standard third-stage care, with 450 mL loss. This cannot show tranexamic acid alone prevented bleeding.
Key findings
01E.B. received tranexamic acid 1 g at delivery of the newborn's anterior shoulder, along with standard active management of third stage of labor, oxytocin, and methergine, and total blood loss was 450 mL.
02In a French randomized trial of 3891 women after vaginal birth, prophylactic tranexamic acid did not significantly reduce postpartum hemorrhage: 8.1% of 1921 tranexamic acid patients and 9.8% of 1918 placebo patients, P = .07.
03That trial included fewer than 5% of women with a previous postpartum hemorrhage and was not powered to answer whether prophylactic tranexamic acid helps women at risk for postpartum hemorrhage.
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What it does not show
The main report is a single case, so it cannot establish that tranexamic acid prevented postpartum hemorrhage. The patient received several treatments together, so the effect of tranexamic acid alone cannot be separated from standard third-stage care, oxytocin, and methergine. The paper also reviews other studies, but the case itself has no comparison group. The French trial of prophylactic tranexamic acid for vaginal birth was not powered to answer whether it helps women at high risk of postpartum hemorrhage.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that tranexamic acid alone prevented postpartum hemorrhage in this patient. She received standard third-stage care, oxytocin, and methergine as well, and a single case cannot show that any one treatment caused the 450 mL blood loss.