Background: Postpartum haemorrhage is an obstetric nightmare. Although it may occur in women with no identified risk, women with certain risk profiles are at increased risk PPH. Tranexamic acid has been shown to be effective in low risk women.

Aim: To compare the effectiveness of Tranexamic acid to placebo in preventing PPH in at-risk women following vaginal delivery.

Research Methods: The study was a randomized controlled trial at ABUTH, Zaria, in which 334 women identified as being at risk for PPH, were sequentially randomized into Tranexamic and placebo groups of 167 each. The Tranexamic acid group received intravenous 1g Tranexamic acid made up to 20ml with 0.9% Normal saline, while the placebo group received 20ml 0.9% Normal saline at delivery. Both groups received I.M 10IU oxytocin as part of AMTSL protocol. Blood loss was collected objectively in a blood collection drape at delivery.

Results: The primary outcome, blood loss >500ml, was significantly lower in the study arm 12.9% versus 27.9% p-value =0.001, while the mean blood loss was also significantly lower in the Tranexamic acid arm, 260.61±183.74 versus 365.84±191.79; p-value <0.001. On the secondary outcomes, there was significant difference in mean haemoglobin fall with significant reduction on the need of additional uterotonic agent in the Tranexamic arm of the study, p-value 0.001. There was no significant difference on the need for blood transfusion, and side effect profile in both arms of study p-value 0.075 and 0.124 respectively.

Conclusion: Tranexamic acid is efficacious in reducing PPH in at-risk women during vaginal delivery.

Keywords: Postpartum haemorrhage, Tranexamic acid, at-risk, vaginal delivery.

1. Say L, Chou D, Gemmill A, Tuncalp O, Moller AB, Daniels J, Gulmezoglu AM, Emmerman M, Alkema L. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health.2014; 2(6):323-33.
2. WHO recommendation for prevention and treatment of postpartum haemorrhage and the WOMAN Trial. 2017. Available from: http://www.who.int> maternal _perinatal _health.
3. Gai MY, Wu LF, Su QF, Tatsumoto K. Clinical observation of blood loss reduced by Tranexamic acid during and after caesarean section: a multicentre randomized trial. Eur J Obstet Gynaecol Reprod Biol.2004:112(2):154-157.
4. Dyer RA, Butwick AJ, Carvalho B. Oxytocin for labour and caesarean delivery: implications for the anaesthesiologist. Current Opinion in Anaesthesiology.2011; 24(3):255-61.
5. Dhivya Lakshmi SJ, Abraham R. Role of prophylactic Tranexamic acid in reducing blood loss during elective caesarean section: A randomised controlled study. J Clin Diagn Res. 2016.10(12):17-21.
6. Novikova N. Hofmeyr GJ. Tranexamic acid for preventing postpartum haemorrhage. Cochrane Database syst Rev, 2010. CD007872.
7. Priyankur R, Sujatha MS, Ambarisha Bhandiwad Biswas B. Role of Tranexamic acid in reducing blood loss in vaginal delivery. J Obstet Gynaecol India. 2016; 66(1):246-250.
8. Peitsidis P, Kadir RA. Antifibrinolytic therapy with tranexamic acid in pregnancy and postpartum. Expert Opin Pharmacother.2011:12(4):503-516.
9. Kwawukume EY, Shittu SO. Postpartum haemorrhage. In: Kwawukume E.Y, Ekele AB, Danso KA, Emuveyan E.E. (Eds). Comprehensive Obstetrics in the Tropics. God Literature Printing Press Limited.2015:145-155.
10. Novikova N. Hofmeyr GJ. Cluver C. Tranexamic acid for preventing postpartum haemorrhage. Cochrane Database syst Rev, 2015, Issue 6.CD007872
11. Ahmadzia HK. Jaclyn MP, Quinton SK, Andra HJ. Tranexamic acid for prevention and treatment of postpartum haemorrhage: An Update on Management and Clinical Outcomes. Obsterics and gynaecological survey.2018; 10:587-594.
12. Mirghafourvand M, Mohammed-Alizadeh S, Abbasalizadeh F. The effect of prophylactic intravenous tranexamic acid on blood loss after vaginal delivery in women at low risk of postpartum haemorrhage: a double blind randomized controlled trial, Aust NZ J Obstet Gynaecol.2015; 55(1):53-8.
13. Sentilhes L. Daniel A, Darsonval A, Deruelle P, Vardon FP, Perrotin F. Study protocol. TRAAP- Tranexamic Acid for preventing postpartum haemorrhage after vaginal delivery: a multicentre randomized, double blind placebo controlled trial. BMC Pregnancy Childbirth.2015; 15: 135.
14. Gungorduk K, Ascioglu O, Yildirim G, Ark C, Tekirdag Al, Besimoglu B. can intravenous tranexamic acid be used in routine practice with active management of third stage of labor in vaginal delivery? A randomized controlled study. Am JPerinatol.2013; 30(5):407-413.
15. Anuchat S, Srisuda S, Metha S. Effectiveness of tranexamic acid for reducing postpartum blood loss in the first two hours after vaginal delivery: A randomized controlled trial. Journal of clinical and diagnostic research.2018: 12(3):1-4.
16. El-Gharhy ET, Mohamed AS, Elshahat A, Elmagd IA, Hamed MA. Tranexamic acid for prevention of postpartum hemorrhage after vaginal delivery. Egypt Journal of hospital Medicine.2018.73 (2):6157-6164.
17. Nggada BJ, Onafowokan O, Offiong RA, Agida ET, Adeka B, Jibrin B. Efficacy of tranexamic acid in reducing blood loss after vaginal delivery. TJOG.2015; 32(1):36.
18. Tushar VS. Sample Size Estimation in Clinical trial. Perspect Clin Res.2010; 1(2):67-69.

Gabriel Dogbanya

Ahmadu Bello University Teaching Hospital Zaria, Dept of Obstetrics and Gynaecology