Tranexamic acid, as an adjunct to oxytocin prophylaxis, in the prevention of postpartum haemorrhage in women undergoing elective caesarean section: A single-centre double-blind randomised controlled trial

Objective: To evaluate the effectiveness of tranexamic acid (TXA) in reducing blood loss during elective caesarean sections in women with and without risk factors for postpartum haemorrhage (PPH).Design: A double-blind, randomised placebo-controlled trial.Setting: An academic tertiary referral centre in Singapore.Population: Multiethnic women aged 21 years or older undergoing elective caesarean section.Methods: Randomisation to intravenous TXA or normal saline (placebo) 10 minutes before skin incision.Main outcome measures: Calculated estimated blood loss (cEBL), derived from blood volume and haematocrit levels.Results: Between June 2020 and October 2021, 200 women were randomised to the placebo or TXA groups. Women who received prophylactic TXA had a significantly lower mean cEBL compared with those receiving placebo (adjusted mean difference - 126.4 mL, 95% CI -243.7 to -9.1, p = 0.035). The effect was greatest in those at high risk for PPH, with a reduction in cEBL (mean difference -279.6 mL, 95% CI -454.8 to - 104.3, p = 0.002) and a lower risk of cEBL >= 500 mL (risk ratio [RR] 0.54, 95% CI 0.36- 0.83, p = 0.007) and cEBL >= 1000 mL (RR 0.44, 95% CI 0.20- 0.98, p = 0.016). Subgroup analysis showed benefit for women with preoperative haemoglobin < 10.5 g/dL (mean difference -281.9 mL, 95% CI -515.0 to -48.8, p = 0.019). There was no significant difference in need for additional medical or surgical interventions. There were no maternal or neonatal adverse outcomes.Conclusion: Prophylactic TXA should be considered in women with risk factors for PPH, and those most likely to benefit are those with preoperative haemoglobin < 10.5 g/dL.

Automated summary

This study evaluated the effectiveness of tranexamic acid (TXA) in reducing blood loss during elective caesarean sections in women with and without risk factors for postpartum haemorrhage (PPH). The results showed that women who received prophylactic TXA had significantly lower blood loss compared with those receiving placebo. The greatest effect was seen in women at high risk for PPH, and subgroup analysis showed benefit for women with preoperative haemoglobin < 10.5 g/dL. There were no significant differences in additional medical or surgical interventions, and no adverse outcomes for mothers or neonates.