Tranexamic acid in prevention of postpartum hemorrhage: a case-control study from Nepal

Introduction: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in low-income countries. WHO recommends the use of tranexamic acid in addition to oxytocin for the prevention and treatment of PPH. However, it is not yet standardized. Our study aims to assess the effectiveness of tranexamic acid in preventing PPH in low-risk patients. Method: This hospital-based case-control study included 60 patients, 30 undergoing vaginal delivery and 30 cesarean delivery. Fifteen cases undergoing vaginal delivery received 1 g tranexamic acid in addition to 10 units of oxytocin, while 15 controls received only oxytocin. 15 cases undergoing cesarean section received 1 g tranexamic acid followed by 6 units of oxytocin after delivery, while 15 controls received only oxytocin. Blood loss after placental delivery and hemoglobin were measured 12 h postpartum. Results: Mean volume of blood loss was lower in the case as compared to the control group in both vaginal delivery (134.05 ± 8.7.85 mL vs. 334.22 ± 280.57 mL, P = 0.01) and cesarean delivery (333.35 ± 139.18 mL vs. 553.74 ± 321.37 mL, P = 0.03). The incidence of PPH was lower in the case as compared to the control group in both vaginal delivery (0% vs 16.66%, P = 0.01) and cesarean delivery (3.33% vs 23.33%, P = 0.02). Mean change in hemoglobin was lower in the case as compared to the control group in both vaginal delivery (0.50 ± 0.65 g/dl vs. 1.77 ± 2.11, P = 0.03) and cesarean section (1.52 ± 1.15 g/dL vs. 2.69 ± 1.81 g/dL, P = 0.00). Blood transfusion was lower in the case as compared to the control group in both vaginal delivery (0% vs. 13.33%, P = 0.03) and cesarean delivery (0% vs. 16.66%, P = 0.01). Conclusion: Tranexamic acid, in addition to oxytocin, reduces the mean amount of blood loss during delivery and helps prevent PPH.