Clinical profile, treatment response, and safety of tranexamic acid in postpartum hemorrhage. A cross-sectional observational study.
DOI:
https://doi.org/10.51168/q311xd64Keywords:
postpartum hemorrhage, tranexamic acid, maternal outcomes, uterine atony, obstetric hemorrhage, tertiary care hospitalAbstract
Background
Postpartum hemorrhage (PPH) remains a major cause of maternal morbidity and mortality, and tranexamic acid (TXA) has emerged as an important adjunct in its management. Real-world evidence from tertiary care hospitals remains valuable for evaluating short-term treatment response and safety.
Objectives
To assess the clinical profile, treatment response, and short-term safety outcomes among women with PPH receiving TXA in a tertiary care teaching hospital.
Methods
This hospital-based observational study included 100 women with clinically diagnosed PPH who received TXA as part of standard management at RVM Institute of Medical Sciences and Research Centre, Telangana, India, from February 2025 to September 2025. Demographic, obstetric, etiological, therapeutic, and outcome-related variables were recorded and analyzed using descriptive statistics.
Results
Most women were aged 21-30 years, multiparous, and delivered vaginally. Uterine atony was the commonest cause of PPH. TXA was administered within 1 hour of diagnosis in 64% of women. Estimated blood loss remained below 1000 mL in 68% after treatment. Additional uterotonics and blood transfusion were required in 32% and 28%, respectively. Hemorrhage was controlled with medical management alone in 78%, whereas 20% required surgical intervention and 3% underwent hysterectomy. Recovery without major complication occurred in 86% of women; ICU admission was required in 11%, and maternal mortality was 2%. Adverse effects were infrequent, with nausea or vomiting in 6%, transient hypotension in 3%, and no thromboembolic events observed.
Conclusion
In this observational cohort, TXA used as part of multimodal PPH management was associated with favorable hemorrhage control and a low short-term adverse-event burden. These findings support its continued integration into tertiary care obstetric hemorrhage protocols.
Recommendation
Early administration of tranexamic acid should be encouraged in postpartum haemorrhage management to reduce blood loss, complications, and improve maternal outcomes.
References
1. Carroli G, Cuesta C, Abalos E, Gulmezoglu AM. Epidemiology of postpartum haemorrhage: a systematic review. Best Pract Res Clin Obstet Gynaecol. 2008;22(6):999-1012. doi:10.1016/j.bpobgyn.2008.08.004.
2. Oyelese Y, Ananth CV. Postpartum hemorrhage: epidemiology, risk factors, and causes. Clin Obstet Gynecol. 2010;53(1):147-156. doi:10.1097/GRF.0b013e3181cc406d.
3. Patek K, Friedman P. Postpartum Hemorrhage-Epidemiology, Risk Factors, and Causes. Clin Obstet Gynecol. 2023;66(2):344-356. doi:10.1097/GRF.0000000000000782.
4. Practice Bulletin No. 183 Summary: Postpartum Hemorrhage. Obstet Gynecol. 2017;130(4):923-925. doi:10.1097/AOG.0000000000002346.
5. Vogel JP, Oladapo OT, Dowswell T, Gulmezoglu AM. Updated WHO recommendation on intravenous tranexamic acid for the treatment of post-partum haemorrhage. Lancet Glob Health. 2018;6(1):e18-e19. doi:10.1016/S2214-109X(17)30428-X.
6. Muñoz M, Stensballe J, Ducloy-Bouthors AS, Bonnet MP, De Robertis E, Fornet I, et al. Patient blood management in obstetrics: prevention and treatment of postpartum haemorrhage. A NATA consensus statement. Blood Transfus. 2019;17(2):112-136. doi:10.2450/2019.0245-18.
7. Shakur H, Elbourne D, Gülmezoglu M, Alfirevic Z, Ronsmans C, Allen E, et al. The WOMAN Trial (World Maternal Antifibrinolytic Trial): tranexamic acid for the treatment of postpartum haemorrhage: an international randomised, double blind placebo controlled trial. Trials. 2010;11:40. doi:10.1186/1745-6215-11-40.
8. WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet. 2017;389(10084):2105-2116. doi:10.1016/S0140-6736(17)30638-4.
9. Brenner A, Ker K, Shakur-Still H, Roberts I. Tranexamic acid for post-partum haemorrhage: what, who and when. Best Pract Res Clin Obstet Gynaecol. 2019;61:66-74. doi:10.1016/j.bpobgyn.2019.04.005.
10. Sentilhes L, Winer N, Azria E, Sénat MV, Le Ray C, Vardon D, et al. Tranexamic acid for the prevention of blood loss after vaginal delivery. N Engl J Med. 2018;379(8):731-742. doi:10.1056/NEJMoa1800942.
11. Sentilhes L, Sénat MV, Le Lous M, Winer N, Rozenberg P, Kayem G, et al. Tranexamic acid for the prevention of blood loss after cesarean delivery. N Engl J Med. 2021;384(17):1623-1634. doi:10.1056/NEJMoa2028788.
12. Ferrari FA, Garzon S, Raffaelli R, Cromi A, Casarin J, Ghezzi F, et al. Tranexamic acid for the prevention and the treatment of primary postpartum haemorrhage: a systematic review. J Obstet Gynaecol. 2022;42(5):734-746. doi:10.1080/01443615.2021.2013784.
13. WOMAN-2 Trial Collaborators. The effect of tranexamic acid on postpartum bleeding in women with moderate and severe anaemia (WOMAN-2): an international, randomised, double-blind, placebo-controlled trial. Lancet. 2024;404(10463):1645-1656. doi:10.1016/S0140-6736(24)01749-5.
14. Ker K, Sentilhes L, Shakur-Still H, Madar H, Deneux-Tharaux C, Saade G, et al. Tranexamic acid for postpartum bleeding: a systematic review and individual patient data meta-analysis of randomised controlled trials. Lancet. 2024;404(10463):1657-1667. doi:10.1016/S0140-6736(24)02102-0.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Dr Manjula D, Dr Akula Swaroopa Rani, Dr Vidyullatha Balivada, Dr Prashanth Kumar Patnaik (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
