What question did this study set out to answer?

This study aims to evaluate the effectiveness of prophylactic tranexamic acid in reducing postpartum blood loss after vaginal delivery based on PPH risk.

June 18, 2026

Efficacy of Prophylactic Tranexamic Acid Use After Vaginal Delivery According to Postpartum Hemorrhage Risk: Randomized, Double‐Blind, Placebo‐Controlled Trial

Key Points

This study aims to evaluate the effectiveness of prophylactic tranexamic acid in reducing postpartum blood loss after vaginal delivery based on PPH risk.
480 singleton pregnant women aged 18-45 delivering at ≥ 34 weeks gestation were included.
Participants were stratified into low-risk and high-risk PPH groups, then randomized to receive tranexamic acid (1 g) or placebo after delivery.
The primary outcome was measured blood loss, with secondary outcomes including uterine atony and need for blood transfusion.
In low-risk patients, tranexamic acid significantly reduced blood loss compared to placebo.
In high-risk patients, tranexamic acid was effective in lowering both blood loss and uterine atony incidence.
The need for blood transfusions and additional uterotonics was lower in the tranexamic acid group, particularly among high-risk individuals.

Abstract

OBJECTIVE: Postpartum hemorrhage (PPH) remains a major cause of maternal morbidity despite standard active management of the third stage of labor. Evidence regarding the prophylactic use of tranexamic acid (TA) after vaginal delivery, particularly according to PPH risk stratification, is limited. This study aimed to evaluate the efficacy of prophylactic intravenous tranexamic acid administered after vaginal delivery in reducing postpartum blood loss. The primary outcome was measured blood loss during the third and fourth stages of labor. Secondary outcomes included the incidence of uterine atony, need for blood transfusion, requirement for additional uterotonics, and treatment-related adverse effects, assessed separately in low- and high-risk PPH groups. MATERIALS AND METHODS: This double-blind, prospective, randomized controlled trial included 480 singleton pregnant women aged 18-45 years who delivered at ≥ 34 weeks of gestation. Participants were first stratified according to postpartum hemorrhage (PPH) risk as low-risk (n = 240) or high-risk (n = 240). Within each risk group, women were randomly assigned in a 1:1 ratio to receive either intravenous tranexamic acid (1 g) or placebo after vaginal delivery (120 participants per treatment arm in each risk group). RESULTS: In low-risk patients, both the collected blood volume and estimated blood loss were significantly lower in the tranexamic acid (TA) group compared with placebo. In high-risk patients, TA administration was associated with significantly reduced collected blood volume and estimated blood loss, as well as a lower incidence of uterine atony. In addition, the need for blood transfusion and additional uterotonic use was lower in patients receiving TA, particularly in the high-risk group. No clinically significant differences were observed in laboratory safety parameters, including D-dimer levels. CONCLUSION: Prophylactic tranexamic acid administration after vaginal delivery significantly reduced postpartum blood loss compared with placebo. While TA was effective in reducing blood loss in both low- and high-risk patients, a significant reduction in uterine atony was observed only in the high-risk group. No major adverse effects related to TA were identified, suggesting that TA was well tolerated in the study population. Major maternal morbidity outcomes were not assessed in this study.

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