Tranexamic Acid for the Prevention of Primary Postpartum Hemorrhage in a High Risk Multigravida

We present a 31 year old chronically anemic G4P3 obstetric patient with a significant history of primary postpartum hemorrhage (PPH) requiring transfusion of blood after prior elective cesarean delivery. Given her history and risk factors for PPH along with her high risk for bleeding secondary to her anemia, the anesthesiologist administered an anti-fibrinolytic medication, tranexamic acid (TXA) after the umbilical cord was clamped, in an attempt to prevent PPH without exposing the neonate to the drug. The patient did not experience PPH nor required blood transfusion. This case report focuses on three important aspects of TXA administration: the timing of administration, the unknown potential effects of TXA on the neonate, and the utilization of the drug on high risk patients. Our case shows that TXA may have helped our high risk patient without exposing the neonate. Although there is promise in the use of TXA for prevention and treatment of PPH, large, high quality randomized controlled trials are necessary before its widespread use can be recommended.