title: Can intravenous injection of tranexamic acid be used in routine practice with active management of the third stage of labor in vaginal delivery? A randomized controlled study.
abstract: OBJECTIVE
  To estimate the effects of adding intravenous tranexamic acid (TA) to the standard active management of third-stage labor to reduce vaginal blood loss during the third and fourth stages of labor.
  
  
  METHODS
  A prospective, double-blind, equivalence randomized, controlled study was performed. Women were randomly allocated to receive an intravenous infusion of TA (experimental group, n = 228) or 5% glucose (placebo group, n = 226) at delivery of the anterior shoulder. Active management of the third stage of labor, which includes prophylactic injection of 10 IU of oxytocin within 2 minutes of birth, early clamping of the umbilical cord, and controlled cord traction following delivery, was used in both groups. The primary outcome was mean blood loss during the third and fourth stages of labor.
  
  
  RESULTS
  Mean estimated blood loss at the third and fourth stages of labor was significantly lower in the experimental group than that in the placebo group (261.5 ± 146.8 mL versus 349.98 ± 188.85 mL, respectively; p < 0.001). The frequency of postpartum hemorrhage > 500 mL was also lower in the experimental group (4, 1.8%) compared with that in the placebo controls (15, [6.8%]; relative risk, 3.76; 95% confidence interval, 1.27 to 11.15; p = 0.01). No episode of thrombosis occurred in the women who received TA.
  
  
  CONCLUSIONS
  The use of TA with standard active management of the third stage of labor reduced postpartum blood loss, and no increase in the incidence of thromboembolic events was observed.
authors.affiliation: Mardin Women and Children Hospital, Mardin, Turkey. maidenkemal@yahoo.com
authors.forename: Kemal
authors.initials: K
authors.lastname: Gungorduk
authors.forename: Osman
authors.initials: O
authors.lastname: Asıcıoğlu
authors.forename: Gokhan
authors.initials: G
authors.lastname: Yıldırım
authors.forename: Cemal
authors.initials: C
authors.lastname: Ark
authors.forename: Ali İsmet
authors.initials: Aİ
authors.lastname: Tekirdağ
authors.forename: Berhan
authors.initials: B
authors.lastname: Besımoglu
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D036861:Delivery, Obstetric; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007749:Labor Stage, Third; D010120:Oxytocics / Q000627:therapeutic use; D010121:Oxytocin / Q000627:therapeutic use; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy; D014148:Tranexamic Acid / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000933:Antifibrinolytic Agents; D010120:Oxytocics; D010121:Oxytocin; D014148:Tranexamic Acid