Prophylactic Use of Tranexamic Acid to Prevent Postpartum Hemorrhage in High-Risk Cesarean Deliveries: A Systematic Review and Meta-Analysis.

Background/

Objective

Postpartum hemorrhage is a leading cause of maternal morbidity and mortality, particularly among high-risk women undergoing cesarean section. This systematic review and meta-analysis evaluated the efficacy and safety of prophylactic tranexamic acid in high-risk cesarean sections.

Methods

A systematic review and meta-analysis of randomized controlled trials was conducted. Risk of bias was assessed using RoB 2.0 and certainty of evidence was evaluated with GRADE. Random-effects meta-analyses, subgroup analyses and sensitivity analyses were performed. PROSPERO: CRD420251087054.

Results

Nine randomized controlled trials involving 1776 participants were included. Tranexamic acid reduced total blood loss (MD -300.78; 95% CI -459.78 to -157.77), with greater efficacy when administered 15-20 min before incision (SMD -0.61; 95% CI -0.82 to -0.39). It also reduced intraoperative blood loss (MD -256.71 mL; 95% CI -375.04 to -138.39), blood loss >1000 mL (RR 0.24; 95% CI 0.14 to 0.41), additional uterotonics (RR 0.37; 95% CI 0.24 to 0.58), blood transfusions (RR 0.30; 95% CI 0.22 to 0.40), and complementary surgical interventions (RR 0.35; 95% CI 0.16 to 0.78).

Conclusions

Prophylactic tranexamic acid may reduce blood loss in high-risk cesarean deliveries, particularly when administered 15-20 min before skin incision. It may decrease total and intraoperative blood loss and blood loss exceeding 1000 mL. It also likely reduces the postoperative decline in hemoglobin, the need for additional uterotonics, blood transfusions, and complementary surgical interventions; however, its effect on hematocrit remains uncertain.