Tranexamic Acid for Reducing Blood Loss in High-Risk Cesarean Delivery

This randomized study evaluated whether prophylactic tranexamic acid (TXA) reduces perioperative blood loss in women at increased risk of postpartum hemorrhage undergoing elective cesarean delivery. Women aged 18-45 years with at least one risk factor for postpartum hemorrhage were included. The anesthesia technique, spinal or general anesthesia, was selected before randomization based on clinical considerations and patient preference. Within each anesthesia group, participants were randomized to receive either 1 g intravenous TXA after umbilical cord clamping or no TXA. The main outcome was estimated blood loss calculated from perioperative hematocrit values. Other outcomes included postpartum hemorrhage, blood transfusion, changes in hemoglobin and hematocrit, need for additional uterotonic medications, adverse events, and thromboembolic events during follow-up.

Inclusion Criteria: * Women aged 18-45 years * ASA physical status II * Gestational age 37-42 weeks * Scheduled for elective cesarean delivery under spinal or general anesthesia * Presence of at least one risk factor for postpartum hemorrhage, including: * Multiple gestation * Previous cesarean delivery * Pregnancy-induced hypertension * Fetal macrosomia * Previous postpartum hemorrhage * Anemia (hemoglobin \