The Effect of Tranexamic Acid on Postpartum Bleeding in Women With Moderate and Severe Anemia (WOMAN-2): An International, Randomized, Double-Blind, Placebo-Controlled Trial

( Lancet . 2024;404:1645–1656. DOI: 10.1016/S0140-6736(24)01749-5) Obstetric hemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality worldwide. The WOMAN trial showed that administering tranexamic acid (TXA) within 3 hours of PPH diagnosis decreased risk of maternal death secondary to PPH. Parturients with moderate and severe anemia are at a higher risk of PPH, and thus morbidity and mortality, due to factors like reduced blood viscosity and increased fibrinolysis. This article analyzed the results of the international WOMAN-2 trial; a double-blind, randomized, placebo-controlled trial aimed to assess whether administering TXA shortly after childbirth could prevent PPH in women with moderate or severe anemia. The trial was conducted across 34 hospitals in 4 countries: Nigeria, Tanzania, Pakistan, and Zambia. Participants were women in active labor with a hemoglobin level of 500 mL or any blood loss severe enough to compromise hemodynamic stability within 24 hours of delivery.