title: Tranexamic acid for preventing postpartum blood loss after cesarean delivery: a systematic review and meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  There are several published clinical trials of the use of tranexamic acid (TXA) in an obstetric setting, but no consensus on its use or guidelines for management.
  
  
  METHODS
  The aim of this meta-analysis was to evaluate the effectiveness of TXA in reducing blood loss when given prior to cesarean delivery. We performed a systematic search in electronic databases. We included all randomized controlled trials comparing the use of TXA prior to cesarean delivery with controls (either placebo or no treatment).
  
  
  RESULTS
  Nine trials with 2365 women were included in the analysis. Women who received TXA had significantly less postpartum blood loss, a lower drop in hemoglobin and a lower incidence of postpartum hemorrhage and severe postpartum hemorrhage compared with controls. Moreover, the number of women who needed additional uterotonic agents was significantly lower in the TXA group than in controls. The percentage of women who required blood transfusions at, or immediately after, cesareans was significantly lower in the intervention group than in the controls. There was no difference in the incidence of thromboembolic events in the two groups.
  
  
  CONCLUSIONS
  Prophylactic TXA given before cesarean skin incision in women undergoing cesarean delivery, under spinal or epidural anesthesia, significantly decreases blood loss, including postpartum hemorrhage and severe postpartum hemorrhage, in addition to the standard prophylactic oxytocin given after delivery of the neonate. The effect of TXA on thromboembolic events and mortality as well as its use in high-risk women should be investigated further.
authors.affiliation: Department of Medical Surgical Sciences, Division of Obstetrics and Prenatal Medicine, St Orsola Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Giuliana
authors.identifier: http://orcid.org/0000-0002-7186-395X
authors.initials: G
authors.lastname: Simonazzi
authors.affiliation: Department of Medical Surgical Sciences, Division of Obstetrics and Prenatal Medicine, St Orsola Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Maria
authors.identifier: http://orcid.org/0000-0002-2013-022X
authors.initials: M
authors.lastname: Bisulli
authors.affiliation: Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.
authors.forename: Gabriele
authors.identifier: http://orcid.org/0000-0003-0078-2113
authors.initials: G
authors.lastname: Saccone
authors.affiliation: Department of Medical Surgical Sciences, Division of Obstetrics and Prenatal Medicine, St Orsola Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Elisa
authors.identifier: http://orcid.org/0000-0003-0342-512X
authors.initials: E
authors.lastname: Moro
authors.affiliation: Department of Hematology and Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.|Department of Hematology, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Ariela
authors.identifier: http://orcid.org/0000-0001-7388-0422
authors.initials: A
authors.lastname: Marshall
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: Vincenzo
authors.identifier: http://orcid.org/0000-0003-2854-0239
authors.initials: V
authors.lastname: Berghella
mesh_terms: D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D010120:Oxytocics / Q000008:administration & dosage; D019106:Postoperative Hemorrhage / Q000097:blood / Q000517:prevention & control*; D006473:Postpartum Hemorrhage / Q000097:blood / Q000517:prevention & control*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D014148:Tranexamic Acid / Q000627:therapeutic use*
chemical_list: D000933:Antifibrinolytic Agents; D006454:Hemoglobins; D010120:Oxytocics; D014148:Tranexamic Acid
keywords: Tranexamic acid; cesarean delivery; postpartum hemorrhage