Effect of Prophylactic Intraoperative Tranexamic Acid on Postpartum Blood Loss Following Cesarean Section at a Single Center

BACKGROUND Postpartum blood loss after cesarean section can be challenging to control, resulting in maternal morbidity and mortality. Tranexamic acid (TXA) is a synthetic reversible plasminogen inhibitor that is approved for the management of heavy menstrual bleeding, but off-label use has been described, including for the control of postpartum hemorrhage (PPH). This study aimed to compare postpartum blood loss after cesarean section in women treated with either tranexamic acid or placebo. MATERIAL AND METHODS This single-center clinical study conducted in Indonesia enrolled 88 women undergoing cesarean section. Participants were randomized into 2 groups: the treatment group (n=44) received 1 g of TXA intravenously at the time of surgical incision, and the placebo group (n=44) received 10 ml of saline. Blood loss was measured using a calibrated surgical suction device and pictogram, with total blood loss calculated by subtracting amniotic and irrigation fluids. RESULTS PPH occurred in 10.2% of all patients. Group A had significantly less blood loss than group B (mean=459.4 ml vs 686.3 ml; P<0.001). TXA was significantly protective, reducing the risk of PPH by 87.5% compared to group B (RR=0.125 [95% CI 0.016-0.958]; P=0.045). There were no significant differences in adverse effects between the 2 groups (P=0.101). CONCLUSIONS Intraoperative TXA administration significantly reduces blood loss and the risk of PPH in women undergoing cesarean sections. These findings support the routine use of TXA in cesarean management protocols to improve maternal safety and outcomes.