Effectiveness of Prophylactic Intravenous Tranexamic Acid in Preventing Postpartum Hemorrhage After Vaginal Delivery: A Quasi-Experimental Study

Abstract

Objective: To evaluate the effectiveness of prophylactic TXA in reducing PPH among women undergoing vaginal delivery  

Methodology: This prospective non-randomized clinical trial included 192 women undergoing vaginal delivery from Sir Ganga Ram Hospital, Lahore, from March 2023 to February 2024. Inclusion criteria were age 18-40 years, gestational amenorrhea >37weeks, parity ≤3, polyhydramnios, induced labour, and previous history of PPH Women in TXA group (n=96) received intravenous TXA 100 mg/mL, and women in SOC group (n=96) received only standard of care (SOC). Gravimetric method was used to estimate blood loss. Independent sample t-test employed to compare blood loss between groups.

Results: Baseline means of age (30.34 ± 8.51 vs. 30.10 ± 7.53 years, p-value 0.822), and BMI (26.01 ± 3.74 vs. 25.80 ± 3.33 Kg/m2, p-value 0.757) were comparable between the two study groups. The proportions of age categories (p-value 0.826), BMI classes (p-value 0.626) and parity (p-value 0.688) were also similar in both groups PPH immediately after delivery of placenta (323.59 ± 49.91 vs. 424.88 ± 41.28 ml; p-value <0.001), and up to 6-hours (70.14±6.54 ml vs. 104.68±8.53 ml; p-value <0.001) in TXA group was significantly lesser than SOC group. Requirement of blood transfusion (3.1% vs. 10.4%; p-value 0.04) in TXA group was significantly lower than SOC group. However, allergic reactions (8.3% vs. 0.0%; p-value 0.007) were only observed in TXA group. Other side effects including nausea/ vomiting (7.3% vs. 2.1%; p-value 0.169), and diarrhoea (6.3% vs. 1.0%; p-value 0.118) were also higher in TXA group, but the difference remained statistically insignificant.

Conclusion: Prophylactic intravenous administration of tranexamic acid significantly reduced postpartum blood loss both immediately after placental delivery and within the first six hours following vaginal delivery.