The Efficacy of Tranexamic Acid in Preventing Postpartum Haemorrhage After Caesarean Section

The Efficacy of Tranexamic Acid in Preventing Postpartum Haemorrhage After Caesarean Section

This study seeks to determine if the using tranexamic acid prophylactically at caesarean section will prevent postpartum haemorrhage which is a major cause of maternal mortality in Zimbabwe and globally.

This trial will be an placebo-controlled, two-centre, randomized control trial with two parallel groups including 1,162 women who undergo elective or emergency caesarean deliveries at term. The study group will receive tranexamic acid (TXA) 1g intravenously at the onset of skin incision. There is normal saline placebo for the control group. The study and control groups will both receive the standard care offered at caesarean section including 5 IU of oxytocin intravenously on delivery of the baby. .

Inclusion Criteria: Women undergoing elective or emergency caesarean section with:

• Estimated gestational age of 37 weeks or more
• Live intrauterine foetus
• Elective or emergency caesarean delivery
• Signed informed consent

Exclusion Criteria:

• History of coagulopathies or conditions predisposing them to thromboembolic phenomena,
• seizure history,
• autoimmune disease,
• placental abruption,
• placenta praevia,
• abnormally adherent placentae if identified on prenatal ultrasound,
• eclampsia or HELLP syndrome,
• known hypersensitivity to TXA,
• planned general anaesthesia,
• caesarean delivery for the second twin or second/third triplet(s) after vaginal birth of the first twin,
• poor understanding of English/Shona languages,
• those who have received anticoagulants in the week before delivery
• persons-under-investigation for Coronavirus disease (COVID-19) and confirmed COVID-19 positive women