A comparative study of efficacy of tranexamic acid in reducing blood loss during and after cesarean section: a randomised control study

Background: Excessive bleeding during and after cesarean section is a major cause of maternal morbidity. TXA acid has been proposed as an effective intervention to reduce blood loss, but evidence from randomized trials is limited. This study aimed to evaluate the efficacy and safety of TXA acid in decreasing intraoperative and postpartum hemorrhage following cesarean delivery. Methods: This prospective, randomized, controlled trial enrolled 120 women undergoing cesarean section at a tertiary care hospital. Participants were randomly assigned to receive either intravenous tranexamic acid (15 mg/kg in 100 ml Ringer’s lactate solution, n=60) or placebo (plain Ringer’s lactate, n=60) after cord clamping. The primary outcome was total blood loss from placental delivery until 2 hours postpartum. Secondary outcomes included change in hemoglobin levels, blood pressure, and adverse events. Results: The tranexamic acid group had significantly lower intraoperative blood loss (421.9±27.9 ml compared to controls (845.9±256.6), p<0.001). Postpartum blood loss from end of surgery to 2 hours was also lower with tranexamic acid (30.8±3.7 ml versus 41.28±3.6 ml, p<0.001). Number of mops and drapes soaked were also less in the interventional group compared to control. Postoperative hemoglobin remained stable in the tranexamic acid group but dropped in controls (p<0.001). No significant differences in adverse events were observed between groups. Conclusions: Prophylactic administration of TXA acid significantly reduced intraoperative and postpartum blood loss following cesarean section while maintaining postoperative hemoglobin levels, without increasing adverse effects. These findings support the use of tranexamic acid as an effective adjunct for hemorrhage prevention in cesarean deliveries.