# Tranexamic acid to prevent bleeding after birth Intervention · id `maternal:tranexamic-acid-pph-prevention` · Maternal & Newborn Atlas · release `c7fb95f1d15a7d13` (public) > General information from published sources, not medical advice, and not reviewed by clinicians. Check the cited source before relying on anything here. The atlas's own text and curation may be reused under Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0, https://creativecommons.org/licenses/by-nc/4.0/): credit the atlas, and do not use it commercially. See the atlas About page. Text quoted from a source stays under that source's own terms, given as the source's reuse\_basis. The atlas's reuse terms do not cover it. The downloads list each quotation with its source in third\_party\_quotations. Browse, life stage: Childbirth; Postpartum Browse, care area: Recovery after birth ## In plain language Tranexamic acid is a medicine that helps blood clots last. Given early, it lowers deaths from bleeding in women who are already bleeding heavily after birth. This page is about a different use: giving it to prevent bleeding in women who are not yet bleeding heavily. In the WOMAN-2 trial, women with moderate or severe anaemia who got tranexamic acid right after a vaginal birth were no less likely to have a postpartum haemorrhage than women given a dummy treatment. The 2025 WHO consolidated guideline does not recommend it for prevention, either at vaginal birth or at caesarean birth. ## Technical summary Prevention use, kept apart from the treatment record (tranexamic-acid-pph-treatment): effects of one use do not transfer to the other. WOMAN-2 (Lancet 2024; PMID 39461792; NCT03475342): 15,068 women with moderate or severe anaemia after vaginal birth in four countries, no reduction in clinically diagnosed PPH. The 2025 global non-recommendation of tranexamic acid for prevention at vaginal birth (Recommendation 14) and at caesarean birth (Recommendation 15) is recorded here as two claims and two decisions, each with its own context; both are in the category Not recommended and new in 2025. The treatment record holds the separate recommendation to use it for PPH that has started. Dose in the trial: 1 g by slow intravenous injection over 10 minutes within 15 minutes of cord clamping. This is not a recommendation to give it. ## Claims, with the population each applies to ## Context: Women at caesarean birth, tranexamic acid considered to prevent postpartum haemorrhage (WHO 2025 Recommendation 15) Recipient: Maternal; Population: Women at caesarean birth, considered for tranexamic acid to prevent postpartum haemorrhage before significant bleeding begins. This is prevention and is a different use from treatment of PPH. WHO's remarks say the recommendation covers all caesarean births at the population level.; Care setting: Not stated in the source; Geography: Global (WHO guidance intended to inform national and subnational policy).; Life stage: Childbirth, before significant bleeding; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not applicable (recommendation context) ### The 2025 WHO consolidated guideline does not recommend tranexamic acid to prevent postpartum haemorrhage at caesarean birth (Recommendation 15, category Not recommended, new in 2025). WHO's justification says the medicine gave no additional benefit in reducing postpartum blood loss over standard preventive measures. No clear increase in maternal or newborn life-threatening adverse events was observed, but WHO noted that a small yet clinically important rise in clot-related (thromboembolic) risk could not be ruled out, which matters most at caesarean birth, when the baseline risk of clots is already higher. WHO's remarks say the recommendation covers all caesarean births at the population level and relies on being able to assess blood loss accurately and diagnose PPH. For certain high-risk women, WHO says clinicians could consider the medicine to control bleeding before the PPH diagnostic criteria are met. Tranexamic acid stays recommended for treating PPH (Recommendations 27 and 29), which is a different use. - Category: Recommendation - Evidence stage: Guidance - Certainty: Certainty not assessed - Applies to: Recipient: Maternal; Population: Women at caesarean birth, considered for tranexamic acid to prevent postpartum haemorrhage before significant bleeding begins. This is prevention and is a different use from treatment of PPH. WHO's remarks say the recommendation covers all caesarean births at the population level.; Care setting: Not stated in the source; Geography: Global (WHO guidance intended to inform national and subnational policy).; Life stage: Childbirth, before significant bleeding; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not applicable (recommendation context) - Limitations: WHO labels each recommendation with one of four categories and a development status. These are not GRADE strength labels, so the claim certainty is left not assessed. The evidence base for this recommendation (Web Annex A, Section 3.13) was not read. WOMAN studied women who were already bleeding and is not evidence for this claim; WOMAN-2 studied women with anaemia after vaginal birth. This claim covers caesarean birth only; Recommendation 14 for vaginal birth is a separate claim. WHO's remarks on timing of the dose and on intrathecal medication errors are not restated. - Last checked: 2026-10-15 - Sources: 1. Supports: Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage (Guideline, edition First edition, 2025. The date is the who.int page date, 5 October 2025, which the atlas uses for WHO sources and decisions; the WHO IRIS record lists an issue date of 2025-09-26 for the same document. The web annexes with the evidence base and the implementation guide were not read.) Locator: Recommendation 15: text, category and justification (caesarean birth). Retrieved 2026-10-11T19:12:00Z. Source state: Current. Snapshot hash: 2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de. How it applies: WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution. 2. Supports: Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage (Guideline, edition First edition, 2025. The date is the who.int page date, 5 October 2025, which the atlas uses for WHO sources and decisions; the WHO IRIS record lists an issue date of 2025-09-26 for the same document. The web annexes with the evidence base and the implementation guide were not read.) Locator: Recommendation 15, Remarks, bullet 1: population-level scope. Retrieved 2026-10-11T19:12:00Z. Source state: Current. Snapshot hash: 2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de. How it applies: WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution. 3. Background: Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage (Guideline, edition First edition, 2025. The date is the who.int page date, 5 October 2025, which the atlas uses for WHO sources and decisions; the WHO IRIS record lists an issue date of 2025-09-26 for the same document. The web annexes with the evidence base and the implementation guide were not read.) Locator: Recommendation 15, Remarks, bullet 3: clinical judgement for high-risk women. Retrieved 2026-10-11T19:12:00Z. Source state: Current. Snapshot hash: 2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de. How it applies: WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution. 4. Background: Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage (Guideline, edition First edition, 2025. The date is the who.int page date, 5 October 2025, which the atlas uses for WHO sources and decisions; the WHO IRIS record lists an issue date of 2025-09-26 for the same document. The web annexes with the evidence base and the implementation guide were not read.) Locator: Recommendation 15, Remarks, bullet 5: treatment stays recommended. Retrieved 2026-10-11T19:12:00Z. Source state: Current. Snapshot hash: 2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de. How it applies: WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution. ## Context: Women at vaginal birth, tranexamic acid considered to prevent postpartum haemorrhage (WHO 2025 Recommendation 14) Recipient: Maternal; Population: Women at vaginal birth, considered for tranexamic acid to prevent postpartum haemorrhage before significant bleeding begins. This is prevention and is a different use from treatment of PPH. WHO's remarks say the recommendation covers all vaginal births at the population level.; Care setting: Not stated in the source; Geography: Global (WHO guidance intended to inform national and subnational policy).; Life stage: Childbirth, before significant bleeding; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not applicable (recommendation context) ### The 2025 WHO consolidated guideline does not recommend tranexamic acid to prevent postpartum haemorrhage at vaginal birth (Recommendation 14, category Not recommended, new in 2025). WHO's justification says the medicine showed no clinical benefit over standard preventive measures in reducing PPH. It found no clear evidence of increased risk of maternal or newborn harms, but agreed that a modest increase in clot-related (thromboembolic) events could not be confidently ruled out. WHO's remarks say the recommendation covers all vaginal births at the population level and relies on being able to assess blood loss accurately and diagnose PPH. Tranexamic acid stays recommended for treating PPH (Recommendations 27 and 29), which is a different use. - Category: Recommendation - Evidence stage: Guidance - Certainty: Certainty not assessed - Applies to: Recipient: Maternal; Population: Women at vaginal birth, considered for tranexamic acid to prevent postpartum haemorrhage before significant bleeding begins. This is prevention and is a different use from treatment of PPH. WHO's remarks say the recommendation covers all vaginal births at the population level.; Care setting: Not stated in the source; Geography: Global (WHO guidance intended to inform national and subnational policy).; Life stage: Childbirth, before significant bleeding; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not applicable (recommendation context) - Limitations: WHO labels each recommendation with one of four categories and a development status. These are not GRADE strength labels, so the claim certainty is left not assessed. The evidence base for this recommendation (Web Annex A, Section 3.12) was not read. WOMAN studied women who were already bleeding and is not evidence for this claim; WOMAN-2 studied women with anaemia after vaginal birth. This claim covers vaginal birth only; Recommendation 15 for caesarean birth is a separate claim. - Last checked: 2026-10-15 - Sources: 1. Supports: Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage (Guideline, edition First edition, 2025. The date is the who.int page date, 5 October 2025, which the atlas uses for WHO sources and decisions; the WHO IRIS record lists an issue date of 2025-09-26 for the same document. The web annexes with the evidence base and the implementation guide were not read.) Locator: Recommendation 14: text, category and justification (vaginal birth). Retrieved 2026-10-11T19:12:00Z. Source state: Current. Snapshot hash: 2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de. How it applies: WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution. 2. Supports: Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage (Guideline, edition First edition, 2025. The date is the who.int page date, 5 October 2025, which the atlas uses for WHO sources and decisions; the WHO IRIS record lists an issue date of 2025-09-26 for the same document. The web annexes with the evidence base and the implementation guide were not read.) Locator: Recommendation 14, Justification: no clear evidence of increased harm. Retrieved 2026-10-11T19:12:00Z. Source state: Current. Snapshot hash: 2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de. How it applies: WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution. 3. Supports: Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage (Guideline, edition First edition, 2025. The date is the who.int page date, 5 October 2025, which the atlas uses for WHO sources and decisions; the WHO IRIS record lists an issue date of 2025-09-26 for the same document. The web annexes with the evidence base and the implementation guide were not read.) Locator: Recommendation 14, Remarks: population-level scope. Retrieved 2026-10-11T19:12:00Z. Source state: Current. Snapshot hash: 2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de. How it applies: WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution. 4. Background: Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage (Guideline, edition First edition, 2025. The date is the who.int page date, 5 October 2025, which the atlas uses for WHO sources and decisions; the WHO IRIS record lists an issue date of 2025-09-26 for the same document. The web annexes with the evidence base and the implementation guide were not read.) Locator: Recommendation 14, Remarks: treatment stays recommended. Retrieved 2026-10-11T19:12:00Z. Source state: Current. Snapshot hash: 2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de. How it applies: WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution. ## Context: Women with moderate or severe anaemia who gave birth vaginally, tranexamic acid within 15 minutes of cord clamping (WOMAN-2) Recipient: Maternal; Population: Women of any age in active labour with moderate or severe anaemia (haemoglobin below 100 g/L) who had given birth vaginally and were randomly assigned to 1 g of tranexamic acid or matching placebo by slow intravenous injection (over 10 minutes) within 15 minutes of the umbilical cord being cut or clamped. Women had not yet had a postpartum haemorrhage that began before the cord was cut or clamped (registry exclusion). This is prevention, a different use from treating bleeding that has started.; Care setting: 34 hospitals across four countries; Geography: Nigeria, Pakistan, Tanzania and Zambia; Life stage: Childbirth, within 15 minutes after vaginal birth; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: The primary outcome was assessed within 24 hours of randomisation. ### WOMAN-2 randomly assigned 7580 women with moderate or severe anaemia who gave birth vaginally to tranexamic acid and 7488 to placebo. Clinically diagnosed postpartum haemorrhage, the primary outcome, occurred in 530 of 7579 women (7.0%) in the tranexamic acid group and 497 of 7487 (6.6%) in the placebo group (risk ratio 1.05, 95% CI 0.94 to 1.19). The authors conclude that tranexamic acid given within 15 minutes of the umbilical cord being clamped did not reduce the risk of clinically diagnosed postpartum haemorrhage. No vascular occlusive events were reported in either group, and there were no treatment-related adverse events or deaths. - Category: Effect - Evidence stage: Interventional - Certainty: Certainty not assessed - Applies to: Recipient: Maternal; Population: Women of any age in active labour with moderate or severe anaemia (haemoglobin below 100 g/L) who had given birth vaginally and were randomly assigned to 1 g of tranexamic acid or matching placebo by slow intravenous injection (over 10 minutes) within 15 minutes of the umbilical cord being cut or clamped. Women had not yet had a postpartum haemorrhage that began before the cord was cut or clamped (registry exclusion). This is prevention, a different use from treating bleeding that has started.; Care setting: 34 hospitals across four countries; Geography: Nigeria, Pakistan, Tanzania and Zambia; Life stage: Childbirth, within 15 minutes after vaginal birth; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: The primary outcome was assessed within 24 hours of randomisation. - Limitations: This is a null result as reported: no reduction in the primary outcome. The primary outcome is a clinical diagnosis of postpartum haemorrhage, which might be an estimated blood loss of more than 500 mL or any blood loss sufficient to compromise haemodynamic stability within 24 hours. 358 (35%) of the 1024 women with postpartum haemorrhage for whom time data were available were diagnosed before the trial treatment had been fully administered, which the authors report. The trial studied prevention in anaemic women after vaginal birth; it does not apply to treating bleeding (the WOMAN trial, a different claim on a different record), to caesarean birth or to women without anaemia. Only the PubMed abstract and the registry JSON were read. - Last checked: 2026-10-14 - Sources: 1. Supports: The effect of tranexamic acid on postpartum bleeding in women with moderate and severe anaemia (WOMAN-2): an international, randomised, double-blind, placebo-controlled trial (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, BACKGROUND, METHODS: question, population, dose and timing, primary outcome. Retrieved 2026-10-14T18:18:29Z. Source state: Current. Snapshot hash: 060d08c5c1626d69ef98a2a2c898fc4c45a5c06d3fa4fdc38aa6c4ee4fc2cda6. How it applies: PubMed abstract; the full text was not retrieved. 2. Supports: The effect of tranexamic acid on postpartum bleeding in women with moderate and severe anaemia (WOMAN-2): an international, randomised, double-blind, placebo-controlled trial (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, FINDINGS, sentences 2, 5, 6, 8 and 9: numbers randomised, timing, primary outcome, safety. Retrieved 2026-10-14T18:18:29Z. Source state: Current. Snapshot hash: 060d08c5c1626d69ef98a2a2c898fc4c45a5c06d3fa4fdc38aa6c4ee4fc2cda6. How it applies: PubMed abstract. 3. Supports: The effect of tranexamic acid on postpartum bleeding in women with moderate and severe anaemia (WOMAN-2): an international, randomised, double-blind, placebo-controlled trial (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, INTERPRETATION. Retrieved 2026-10-14T18:18:29Z. Source state: Current. Snapshot hash: 060d08c5c1626d69ef98a2a2c898fc4c45a5c06d3fa4fdc38aa6c4ee4fc2cda6. How it applies: PubMed abstract. ## Guidance, authorization and access ### Recommendation `maternal:rec-who-2025-pph-14` - Intervention: Tranexamic acid to prevent bleeding after birth (`maternal:tranexamic-acid-pph-prevention`) - Direction: Recommended against - Issued by: World Health Organization (`maternal:who`) - Guideline record: Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage (WHO, FIGO and ICM, 2025) (`maternal:pub-who-2025-pph`) - Guideline: Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage, edition First edition, 2025. The date is the who.int page date, 5 October 2025, which the atlas uses for WHO sources and decisions; the WHO IRIS record lists an issue date of 2025-09-26 for the same document. The web annexes with the evidence base and the implementation guide were not read.; snapshot `maternal:who-9789240115637-pdf-2026-10-11` - Jurisdictions: Global; note: Global (WHO guidance intended to inform national and subnational policy). Co-published with FIGO and ICM. - Strength: Not recommended (WHO 2025 consolidated PPH guideline. Each recommendation falls in one of four categories (Recommended, Not recommended, Recommended only in specific contexts, Recommended only in the context of rigorous research) and carries a development status (New, Updated, Revalidated or Edited). These are not GRADE strength labels. Recommendation 14 is New.) - Effective: 2025-10-05 (The who.int page date, 5 October 2025 (2025-10-05), is the effective date under the atlas rule for WHO decisions. The WHO IRIS record lists an issue date of 2025-09-26. Both dates are kept.) - Applies to: Recipient: Maternal; Population: Women at vaginal birth, considered for tranexamic acid to prevent postpartum haemorrhage before significant bleeding begins. This is prevention and is a different use from treatment of PPH. WHO's remarks say the recommendation covers all vaginal births at the population level.; Care setting: Not stated in the source; Geography: Global (WHO guidance intended to inform national and subnational policy).; Life stage: Childbirth, before significant bleeding; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not applicable (recommendation context) - Basis: claim `maternal:claim-who-2025-pph-14-txa-prevention-vaginal-birth` ### Recommendation `maternal:rec-who-2025-pph-15` - Intervention: Tranexamic acid to prevent bleeding after birth (`maternal:tranexamic-acid-pph-prevention`) - Direction: Recommended against - Issued by: World Health Organization (`maternal:who`) - Guideline record: Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage (WHO, FIGO and ICM, 2025) (`maternal:pub-who-2025-pph`) - Guideline: Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage, edition First edition, 2025. The date is the who.int page date, 5 October 2025, which the atlas uses for WHO sources and decisions; the WHO IRIS record lists an issue date of 2025-09-26 for the same document. The web annexes with the evidence base and the implementation guide were not read.; snapshot `maternal:who-9789240115637-pdf-2026-10-11` - Jurisdictions: Global; note: Global (WHO guidance intended to inform national and subnational policy). Co-published with FIGO and ICM. - Strength: Not recommended (WHO 2025 consolidated PPH guideline. Each recommendation falls in one of four categories (Recommended, Not recommended, Recommended only in specific contexts, Recommended only in the context of rigorous research) and carries a development status (New, Updated, Revalidated or Edited). These are not GRADE strength labels. Recommendation 15 is New.) - Effective: 2025-10-05 (The who.int page date, 5 October 2025 (2025-10-05), is the effective date under the atlas rule for WHO decisions. The WHO IRIS record lists an issue date of 2025-09-26. Both dates are kept.) - Applies to: Recipient: Maternal; Population: Women at caesarean birth, considered for tranexamic acid to prevent postpartum haemorrhage before significant bleeding begins. This is prevention and is a different use from treatment of PPH. WHO's remarks say the recommendation covers all caesarean births at the population level.; Care setting: Not stated in the source; Geography: Global (WHO guidance intended to inform national and subnational policy).; Life stage: Childbirth, before significant bleeding; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not applicable (recommendation context) - Basis: claim `maternal:claim-who-2025-pph-15-txa-prevention-caesarean-birth` ## Connected pages - WOMAN-2: no reduction in clinically diagnosed PPH in anaemic women after vaginal birth: Postpartum haemorrhage (`maternal:postpartum-hemorrhage`) [a claim, not a settled fact; see claim `maternal:claim-tranexamic-acid-prevention-woman-2` and its context] - Same medicine, different use; effects do not transfer (existing record): Tranexamic acid for treating postpartum haemorrhage (`maternal:tranexamic-acid-pph-treatment`) - WHO 2025 Recommendation 14: not recommended to prevent PPH at vaginal birth: Postpartum haemorrhage (`maternal:postpartum-hemorrhage`) [a claim, not a settled fact; see claim `maternal:claim-who-2025-pph-14-txa-prevention-vaginal-birth` and its context] - WHO 2025 Recommendation 15: not recommended to prevent PPH at caesarean birth: Postpartum haemorrhage (`maternal:postpartum-hemorrhage`) [a claim, not a settled fact; see claim `maternal:claim-who-2025-pph-15-txa-prevention-caesarean-birth` and its context] - Filed under this front: Medicines and vaccines (`maternal:front-medicines-and-vaccines`) - Related to: Tranexamic acid (`maternal:tranexamic-acid`) - Investigated in: WOMAN-2 trial (tranexamic acid in women with anaemia) (`maternal:woman-2-trial`) ## Provenance Content hash: c74050f7c1c50dfcbca0e6a67b47c1f3c52916df93f9537c822b0de3cb59dcc2 Last substantive edit: 2026-10-15 Evidence last checked: 2026-10-15