Tranexamic acid for antenatal bleeding of unknown origin in the second and third trimesters: A prospective clinical trial

Background and objective: Vaginal bleeding is a common complication in pregnancy and is associated with poor perinatal outcomes. This study aimed to determine the efficacy of tranexamic acid in stopping vaginal bleeding during pregnancy and improving perinatal outcomes. Methods: A prospective clinical trial was conducted on 137 pregnant women with vaginal bleeding of unknown causes in the second and third trimesters of pregnancy who were admitted to Maternity Teaching Hospital, Erbil city, Kurdistan region, Iraq from February 2016 to November 2019. Tranexamic acid was administered to one group and normal supportive care to another group in a sequential manner. The Mann–Whitney test was used to compare the mean rank of the times of admission. Factors that were significantly associated with stoppage of bleeding were entered into a binary logistic regression model. Results: Bleeding was stopped in 90% of women who received tranexamic acid. There was a significant difference in low Apgar score, the rate of low birth weight, and the rate of unfavorable perinatal outcome in the supportive care group than that in the tranexamic acid group. Predictors for not stopping bleeding were supportive care management compared with tranexamic acid (odds ratio (OR) = 13.38; 95% confidence interval (CI) = 3.60–49.67), and 21–32 weeks gestation compared with ≥ 37 weeks (OR = 6.52; 95% CI = 1.66–25.63). Conclusion: Tranexamic acid in second and third trimesters bleeding is effective for rapidly arresting bleeding with a favorable neonatal outcome. Keywords: Antifibrinolytic agent; Miscarriage; Neonatal death; Preterm labor; Tranexamic acid.