Efficacy and Safety of Early Administration of IV Tranexamic Acid in the Prevention of Atonic Postpartum Hemorrhage during Cesarean Section – A Randomized Controlled Study

BACKGROUND: Postpartum hemorrhage remains a major cause of maternal morbidity and mortality. Tranexamic acid may reduce blood loss by inhibiting fibrinolysis. AIM: To evaluate the efficacy and safety of prophylactic intravenous tranexamic acid administered before skin incision for prevention of atonic postpartum hemorrhage during cesarean section. MATERIALS AND METHODS: This single-center randomized controlled study included 240 women undergoing cesarean delivery. Participants were randomized to receive either 1 g intravenous tranexamic acid or 10 mL normal saline before skin incision, along with standard active management of the third stage of labor. The primary outcome was calculated estimated blood loss. Secondary outcomes included atonic postpartum hemorrhage, additional uterotonic requirement, blood transfusion, percentage fall in hemoglobin, and adverse events. RESULTS: Mean calculated estimated blood loss was significantly lower in the tranexamic acid group than in the placebo group (578 ± 291 mL vs. 684 ± 245.26 mL; P = 0.002). The incidence of postpartum hemorrhage, need for additional uterotonics, blood transfusion, and percentage fall in hemoglobin were lower in the tranexamic acid group, but these differences were not statistically significant. Minor adverse effects were comparable between groups, and no thromboembolic events or visual disturbances were observed. CONCLUSION: Prophylactic intravenous tranexamic acid administered before skin incision significantly reduces blood loss during cesarean delivery without increasing adverse effects TXA appears to be a safe and useful adjunct to routine uterotonic therapy in women undergoing cesarean section.