The Prophylactic Role of Tranexamic Acid in Reducing Blood Loss During Cesarean Delivery: A Prospective Randomized Controlled Trial

Background: Postpartum hemorrhage (PPH) is a major risk associated with cesarean delivery. This randomized controlled trial (RCT) aimed to evaluate the prophylactic role of intravenous tranexamic acid (TXA) in reducing total intraoperative blood loss in women undergoing lower-segment cesarean section (LSCS). Materials and methods: The study was conducted at the Autonomous State Medical College, Fatehpur, from September 1, 2024, to March 31, 2025. The primary aim of the trial was to investigate the effect of TXA on perioperative and postoperative blood loss during cesarean section in a low-resource setting. A simple randomization technique was used to allocate 300 participants to either group in a 1:1 ratio. Results: The median estimated blood loss (EBL) was identical in both groups at 450 mL (IQR, 250-1000 mL), as measured by the gravimetric method. The mean EBL was lower in the TXA group (460.33 mL) than in the placebo group (511.93 mL) (p < 0.05). The mean changes in hemoglobin level and packed cell volume (PCV) were similar between the two groups. There was no statistically significant difference between the groups in the need for additional uterotonics (misoprostol, carboprost, or carbetocin). Blood transfusions were required in 4.7% (7 cases) of the TXA group and 9.3% (14 cases) of the placebo group. Gastrointestinal side effects were reported in 42.0% of the TXA group and 37.3% of the placebo group. No thromboembolic events were reported in either group. The mean birth weight and mean APGAR scores at one minute were comparable between the two groups. Conclusion: This study supports the prophylactic use of TXA during cesarean delivery to reduce intraoperative blood loss. The significant reduction in mean EBL, combined with the absence of major adverse effects, underscores the role of TXA as a safe and effective adjunct to standard uterotonic therapy.