Intravenous tranexamic acid for reducing blood loss during cesarean delivery: A double-blind, randomized-controlled trial

Background: Cesarean delivery (CD) has been associated with an increased risk of postpartum hemorrhage (PPH) and maternal mortality. Tranexamic acid (TXA) has proven effective in managing hemorrhage, but its overall effect on blood loss during CD when given before skin incision is yet to be evaluated. Materials and Methods: We recruited 154 consenting pregnant women, scheduled for CDs at the University College Hospital, Ibadan, between October 1, 2015 and March 31, 2016. Participants were randomly allocated to receive either 1 g of TXA or placebo given intravenously, 10 min before skin incision. All participants had intravenous oxytocin postdelivery. Operative blood loss, as the primary outcome, was measured by weight and volume at entry into the peritoneal cavity, at the end of the surgery, and 2 h postsurgery. Results: Both groups, with 77 women each, had similar baseline characteristics, obstetrics history, and blood loss from skin incision to the peritoneal cavity. Blood loss from uterine incision to 2 h postsurgery was significantly lower among the TXA group (613.05 ± 195.63 ml vs. 751.17 ± 250.66 ml; P < 0.001). Neonatal outcomes and the need for additional uterotonics were similar in the two groups. Conclusion: TXA significantly reduced blood loss during CD with no adverse events. Routine use of TXA during CDs will further reduce the impact of PPH.