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

Abstract

AbstractObjectiveTo 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).DesignA double‐blind, randomised placebo‐controlled trial.SettingAn academic tertiary referral centre in Singapore.PopulationMultiethnic women aged 21 years or older undergoing elective caesarean section.MethodsRandomisation to intravenous TXA or normal saline (placebo) 10 minutes before skin incision.Main outcome measuresCalculated estimated blood loss (cEBL), derived from blood volume and haematocrit levels.ResultsBetween 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.ConclusionProphylactic 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.