title: Policy of high-dose tranexamic acid for treating postpartum hemorrhage after vaginal delivery.
abstract: OBJECTIVE
  To assess whether a policy of routine administration of high-dose tranexamic acid (TA) at the diagnosis of postpartum hemorrhage (PPH) reduces blood loss after vaginal birth.
  
  
  METHODS
  This controlled single-center before-and-after study of all women with PPH ≥ 500 ml after vaginal birth took place from January 2011 through March 2012; the control group included those seen from January 2011 through August 2011, and the case patients those from September 2011 through March 2012. Our protocol for the management of PPH was modified effective September 2011 to include administration of high-dose TA (4 g of TA intravenously then 1 g/h for 6 h) once blood loss reached 800 ml. Our primary objective was to assess the efficacy of this policy in reducing blood loss in PPH.
  
  
  RESULTS
  Maternal characteristics did not differ between the two groups. Mean estimated blood loss was not significantly lower in the TA group (n = 138) than in the control group (n = 151) (respectively, 915.7 ± 321 ml versus 944.8 ± 313.8 ml; p = 0.47). The difference between pre- and post-delivery hemoglobin levels were lower in the TA group (-2.6 g/dl ± 1.2 versus -2.9 g/dl ± 1.3; p = 0.09), but it was not significant. Postpartum iron sucrose injections were significantly less frequent in the TA than the control group (2.2% versus 9.9%; p < 0.05).
  
  
  CONCLUSIONS
  A policy of high-dose TA in PPH after vaginal deliveries was not associated with a significant reduction of blood loss.
authors.affiliation: a Department of Obstetrics and Gynecology , Angers University Hospital , Angers , France.
authors.forename: Pierre-Emmanuel
authors.initials: PE
authors.lastname: Bouet
authors.affiliation: a Department of Obstetrics and Gynecology , Angers University Hospital , Angers , France.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Ruiz
authors.affiliation: a Department of Obstetrics and Gynecology , Angers University Hospital , Angers , France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Legendre
authors.affiliation: a Department of Obstetrics and Gynecology , Angers University Hospital , Angers , France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Gillard
authors.affiliation: a Department of Obstetrics and Gynecology , Angers University Hospital , Angers , France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Descamps
authors.affiliation: a Department of Obstetrics and Gynecology , Angers University Hospital , Angers , France.
authors.forename: Loïc
authors.initials: L
authors.lastname: Sentilhes
mesh_terms: D000328:Adult; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D005260:Female; D005290:Ferric Compounds / Q000627:therapeutic use; D000077605:Ferric Oxide, Saccharated; D005602:France / Q000453:epidemiology; D005937:Glucaric Acid / Q000627:therapeutic use; D006397:Hematinics / Q000627:therapeutic use; D006801:Humans; D006473:Postpartum Hemorrhage / Q000188:drug therapy*; D011247:Pregnancy; D015995:Prevalence; D013923:Thromboembolism / Q000453:epidemiology; D014148:Tranexamic Acid / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000933:Antifibrinolytic Agents; D005290:Ferric Compounds; D006397:Hematinics; D014148:Tranexamic Acid; D000077605:Ferric Oxide, Saccharated; D005937:Glucaric Acid
keywords: Estimated blood loss; postpartum hemorrhage; tranexamic acid; vaginal delivery