Tranexamic Acid's Limited Impact on Preventing Postpartum Haemorrhage After Vaginal Birth

Postpartum haemorrhage (PPH) is a common and potentially life-threatening condition. Tranexamic acid (TXA), an antifibrinolytic drug, has been considered for its potential to prevent PPH following vaginal birth. A recent review updated the evidence from a 2015 study, focusing on the effects of TXA compared to placebo or no treatment in women after vaginal birth.

Key Findings:

• Blood Loss: TXA results in little to no difference in blood loss ≥ 500 mL and likely makes little to no difference in blood loss ≥ 1000 mL.
• Severe Morbidity and Blood Transfusions: There is little to no difference in severe morbidity or the need for blood transfusions with TXA use.
• Additional Surgical Interventions: TXA may result in little to no difference in the need for additional surgical interventions to control PPH.
• Use of Additional Uterotonics: TXA reduces the use of additional uterotonics in women without anaemia but shows little to no difference in women with anaemia.
• Serious Adverse Events: The evidence is insufficient to draw conclusions about the effect of TXA on maternal death, thromboembolic events, hysterectomy, or seizures.
• Maternal Satisfaction: TXA likely results in little to no difference in maternal satisfaction.

Conclusion: The review concludes that adding prophylactic TXA to standard care for women during vaginal birth does not significantly benefit blood loss outcomes or related morbidity. The evidence on serious adverse events remains very uncertain, suggesting that routine administration of prophylactic TXA for all women having vaginal births may not be justified based on current evidence.