Efficacy of Tranexamic Acid in Active Management of the Third Stage of Labor: A Focus on Blood Loss in Full-Term Vaginal Births

Objective: This study aims to evaluate the efficacy of tranexamic acid (TXA) as an adjunct in the active management of the third stage of labor (AMTSL) in reducing blood loss and preventing postpartum hemorrhage (PPH) in full-term vaginal deliveries. Methods: A literature review was conducted, including randomized controlled trials, systematic reviews, and meta-analyses focusing on the prophylactic use of TXA during AMTSL. The primary outcomes examined were total postpartum blood loss, incidence of PPH (≥500 mL), and safety profile regarding thromboembolic events. Results: Evidence consistently supports that the administration of TXA during AMTSL significantly reduces postpartum blood loss and decreases the incidence of PPH by up to 40% in full-term vaginal deliveries. Studies also confirm the safety of TXA, with no significant increase in thromboembolic complications observed. TXA's antifibrinolytic mechanism stabilizes fibrin clots, complementing uterotonic agents such as oxytocin. Optimal outcomes are achieved with a 1 g intravenous dose administered immediately after delivery of the placenta. Conclusions: TXA is a safe and effective intervention to enhance AMTSL and mitigate blood loss in full-term vaginal deliveries. Its integration into routine obstetric practice could reduce maternal morbidity and mortality, particularly in low-resource settings. Further research is warranted to standardize protocols and assess long-term maternal outcomes.