Introducing tranexamic acid into the protocol for management of post-partum haemorrhage: An observational study using repeated cross-sectional analysis

Abstract

Objective: Primary post-partum haemorrhage (PPH) is an important cause of maternal morbidity and mortality. Following the WOMAN trial, tranexamic acid (TXA) was endorsed as an important component of PPH management, because it was shown to reduce the risk of maternal death due to bleeding. This study aimed to assess changes in maternal outcomes in relation to PPH following vaginal birth pre and post the introduction of TXA into the PPH management policy at a tertiary level Australian Maternity Hospital.

Materials and methods: A repeated cross-sectional analysis was performed, assessing outcomes for the two years before, and two years after the introduction of TXA into the PPH management protocol. The primary outcome was estimated blood loss at PPH. Additional outcomes assessed were red cell transfusion post-delivery, iron infusion post-delivery and operative management of PPH. Maternal characteristics were described and compared. Multinomial logistic regression was used to estimate the unadjusted and adjusted relative risk of having blood loss 1000-1499 mL or ≥1500 mLs (with reference 500-999 mLs) pre and post TXA.

Results: This policy change did not confer a difference in maternal outcomes. Surprisingly, there was an increased risk of PPH ≥ 1500 mLs in both adjusted and unadjusted models. Given the observational nature of our study, it is likely this finding is due to an unknown confounder.

Conclusions: The incidence of severe PPH increased despite alteration to our management protocol to include 1 g of TXA. Ongoing research is required to determine factors contributing to PPH, and the optimal medical management.

Keywords: Obstetrics; Post-partum haemorrhage; Tranexamic acid.