Prevention of Postpartum Hemorrhage With TXA

Hemorrhage remains the leading cause of maternal mortality worldwide. In a 2014 systematic
analysis of the causes of maternal death, the World Health Organization (WHO) noted that even
in the face of interventions developed to actively manage the third stage of labor, 27.1% of
maternal deaths were directly attributable to excessive blood loss.

Risk factors for postpartum hemorrhage (PPH) have been identified, but the majority of cases
occur in low risk women. As such, the routine use of oxytocin in the third stage of labor is
recommended in all women and has been well documented to reduce the risk of excessive blood
loss. Uterotonics such as methylergonovine, 15-methyl PGF2α and misoprostol have shown to be
particularly useful adjuncts as decreased uterine tone is the most common etiology of blood
loss. More recently, tranexamic acid (TXA) has been shown to be efficacious in the prevention
of postpartum hemorrhage in certain cohorts.

Tranexamic acid exerts its effect through the binding of plasmin and subsequent inhibition of
fibrin degradation. It is regarded as pregnancy category B by the Food and Drug
Administration (FDA).

Inclusion Criteria:

- Pregnant female presenting to Navy Medical Center San Diego for delivery

- Able to speak and understand English

- Planning to deliver at NMCSD

Exclusion Criteria:

- Age less than 18 years

- Unable to speak or understand English

- Not planning to deliver at NMCSD

- Planned cesarean hysterectomy

- Current anticoagulant use

- Current subarachnoid hemorrhage

- Any active/current intravascular clotting (i.e. venous thromboembolic events)

- Patients with a hypersensitivity to TXA or any of the ingredients

- Personal history of venous or arterial thrombotic events

- Conditions that predispose patients to thromboembolic events (e.g. thrombophilias,
autoimmune diseases such as lupus, active cancer, congestive heart failure, family
history of thrombosis in a first degree relative at age < 30 years) due to increased
risk of thrombosis

- Patients taking factor IX complex concentrates or anti-inhibitor coagulant
concentrates (e.g. FEIBA NF)

- Eclampsia or seizure disorder because the use of tranexamic acid has been associated
with postoperative seizures

- Patients with a baseline creatinine 1.2 or higher, history of renal insufficiency, or
renal disease because of the risk of toxicity in patients with preexisting disease

- Patients with frank hematuria because ureteral obstruction due to clot formation has
been reported in patients with upper urinary tract bleeding who were treated with
tranexamic acid

- Patients with active or history of retinal diseases as cases of central retinal artery
and central retinal vein obstruction have been reported in patients treated with
intravenous tranexamic acid

- Patients with acquired defective color vision