Research Finds IV Tranexamic Acid Dramatically Reduces Blood Loss in Caesarean Sections

C-Section Blood Loss: Can Antifibrinolytics Change the Game?

Despite routine use of oxytocin and improved surgical techniques, primary postpartum haemorrhage (PPH) remains a leading cause of maternal morbidity and mortality globally. As C-section rates climb, clinicians must consider every tool to minimize bleeding and optimize patient outcomes during and after cesarean delivery.

Study Design: Robust Randomized Evidence

Investigators conducted a double-blind, randomized, placebo-controlled trial at University of Abuja Teaching Hospital to assess whether IV tranexamic acid (TXA), an antifibrinolytic, reduces blood loss during and after elective C-section. Eighty-two women at term (37–42 weeks) were randomized to receive either 1g TXA IV or placebo 15 minutes before incision. Both groups also received standard oxytocin management.

Eligible patients had singleton pregnancies and no major contraindications to TXA (e.g., coagulopathy, thromboembolic history, or allergy). Blood loss was quantified using both hematologic parameters and calculated estimated blood volume, capturing changes in pre- and postoperative hemoglobin/hematocrit.

Key Results: Less Blood Loss, Less Decline in Hemoglobin, Fewer Uterotonics

Blood loss was 457.9 mL lower, on average, in the TXA group vs. placebo (725 mL vs. 1183 mL; p=0.045)

Mean postoperative hemoglobin was significantly higher in the TXA group (10.5 g/L) than placebo (9.7 g/L)

Decline in hemoglobin and hematocrit was smaller with TXA use, reducing risk for postpartum anemia

Only 28% of TXA patients needed additional uterotonics, compared to 78% in the placebo group

No statistically significant differences in surgical time, transfusion rates, or neonatal outcomes (Apgar scores comparable); side effect rates were also similar across groups

Clinical Implications: A Potential Shift in Hemorrhage Prevention

This trial strongly supports adding preoperative IV TXA to the perioperative regimen for women undergoing cesarean delivery—particularly when hemorrhage risk is high or blood conservation is critical. By reducing blood loss and minimizing the need for additional uterotonics, TXA offers an effective, low-cost, and accessible intervention that may help decrease the burden of postpartum anemia and reduce reliance on transfusions. Importantly, this study found no major safety signals in the mother or newborn.

Why This Matters in Practice

With postpartum anemia and hemorrhage remaining stubbornly prevalent, this study provides actionable evidence for using TXA as a standard adjunct to oxytocin during cesarean section. Its safety and efficacy profile aligns with broader global research and can guide both protocol development and bedside care.

Conclusion

Preoperative IV tranexamic acid is a powerful tool for reducing blood loss in cesarean delivery, decreasing the need for additional uterotonics, and protecting mothers from postpartum anemia—without compromising safety or neonatal outcomes. Consider incorporating it into C-section care bundles to further decrease maternal morbidity.

Key Points

IV tranexamic acid cut C-section blood loss by nearly 460 mL compared to placebo

Women receiving TXA had higher postoperative hemoglobin/hematocrit and less decline

Fewer additional uterotonics were needed with TXA (28% vs 78%)

No major maternal or neonatal safety concerns were detected

TXA is an effective, accessible adjunct for PPH prevention in cesarean deliveries

Citation:

Chinonso Beata Okere, Francis Olayemi Adebayo, Eyaofun Teddy Agida, Malachi Emeka Ayogu, Gift Oziakachi Tom-George, Uchechukwu George Ogbu, Hajarah Aliyu-Bima. Effect of intravenous tranexamic acid on blood loss reduction during and after caesarean section: a randomised controlled study. BMC Pregnancy and Childbirth. 2026; Article in Press. DOI: https://doi.org/10.1186/s12884-026-10044-0