Expecting two, delivering three: A case of tranexamic acid and the hidden triplet

We describe a clinical case where a pregnant woman with twin gestation was given Tranexamic Acid (TXA) after delivery of her two neonates but was found to have a third fetus during placenta removal. Tranexamic acid is an antifibrinolytic agent that has been widely studied for its potential in reducing Postpartum Hemorrhage (PPH) [1]. Postpartum hemorrhage, defined as bleeding ≥500 mL in the first 24 hours after delivery, is responsible for 25% of all maternal deaths worldwide [1]. Despite advances in obstetric care, PPH remains a significant concern. Several studies, including the WOMAN Randomized Controlled Trial (RCT), have investigated the effects of TXA in women with PPH [2]. Results demonstrate that the use of TXA significantly reduces maternal death due to bleeding, without any increase in maternal adverse events. These benefits were particularly pronounced when TXA was administered within three hours of birth. Few studies, however, have thoroughly investigated the effects of TXA on neonates in utero.