Role of intravenous tranexamic acid on cesarean blood loss: A prospective randomized study

Background: Postpartum hemorrhage (PPH) is a major cause of maternal mortality globally. Tranexamic acid, an anti‑fibrinolytic agent, is a novel approach to prevent this dreadful complication. This study aims to document the efficacy of intravenous (IV) tranexamic acid in reducing blood loss during and after cesarean section (CS).Materials and Methods: In this prospective, randomized, placebo‑controlled, open‑label study, 100 mothers scheduled for elective CS were randomly selected and divided into two groups (study and control) of 50 each. The study group received 1 g IV tranexamic acid and the control group received IV placebo. Following delivery, all mothers received 10 units of oxytocin in 500 mL of normal saline.Results: The mean intraoperative and postpartum blood loss were significantly lower in the study group than the control group: 499.11 ± 111.2 ml and 59.93 ± 12.5 ml versus 690.85 ± 198.41 ml and 110.06 ± 13.47ml, respectively (P < 0.001). Total blood loss was 30% less in the study group (P < 0.001). Six mothers had PPH in the control group while none in the study group had PPH. The difference between the preoperative and postoperative hemoglobin values was significantly less in the study group than the control group, 0.26 ± 0.22 g% versus 0.99 ± 0.48 g% (P < 0.001).There was no significant difference with respect to other hematologic parameters. There was no added adverse effect or need for NICU admission in the study group.Conclusion: Preoperative IV tranexamic acid significantly reduced blood loss during elective CS without any significant adverse effects.Keywords: Anti‑fibrinolytics; blood‑loss; cesarean delivery; postpartum hemorrhage; Tranexamic aci