{ "release_id": "c7fb95f1d15a7d13", "id": "maternal:tranexamic-acid-pph-prevention", "owner": "maternal", "kind": "intervention", "slug": "tranexamic-acid-pph-prevention", "name": "Tranexamic acid to prevent bleeding after birth", "aliases": [], "atlases": [ "maternal" ], "summary_plain": "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.", "summary_technical": "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.", "editorial_state": "draft", "last_substantive_edit": "2026-10-15", "last_evidence_check": "2026-10-15", "next_review_due": null, "identifiers": [], "navigation": { "maternal": { "life-stage": [ "childbirth", "postpartum" ], "care-area": [ "postpartum-recovery" ] } }, "payload": { "subtype": "medicine", "mechanism": null, "components": null }, "content_digest": "c74050f7c1c50dfcbca0e6a67b47c1f3c52916df93f9537c822b0de3cb59dcc2", "review": { "content_digest": "c74050f7c1c50dfcbca0e6a67b47c1f3c52916df93f9537c822b0de3cb59dcc2", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "claims": [ { "release_id": "c7fb95f1d15a7d13", "id": "maternal:claim-tranexamic-acid-prevention-woman-2", "owner": "maternal", "subject_entity_id": "maternal:tranexamic-acid-pph-prevention", "category": "effect", "statement": "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.", "context": { "id": "maternal:ctx-woman-2-anaemic-women-vaginal-birth", "label": "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_note": "Childbirth, within 15 minutes after vaginal birth", "life_stage_terms": null, "gestational_age_min_days": null, "gestational_age_max_days": null, "gestational_age_basis": null, "postnatal_age_min_days": null, "postnatal_age_max_days": null, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "The primary outcome was assessed within 24 hours of randomisation.", "eligibility": { "inclusion": [ "Women in active labour with moderate or severe anaemia (haemoglobin below 100 g/L), who gave birth vaginally" ], "exclusion": [ "Registry exclusions: women under 18 years who are not accompanied by a guardian, known allergy to tranexamic acid, and postpartum haemorrhage before the cord was cut or clamped" ] } }, "evidence_stage": "interventional", "certainty": "not_assessed", "certainty_method": null, "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.", "editorial_state": "draft", "checked_at": "2026-10-14", "next_review_due": null, "valid_from": null, "valid_to": null, "citations": [ { "evidence_role": "supports", "locator": "Abstract, BACKGROUND, METHODS: question, population, dose and timing, primary outcome", "applicability_note": "PubMed abstract; the full text was not retrieved.", "snapshot": { "id": "maternal:pubmed-39461792-2026-10-14", "retrieved_at": "2026-10-14T18:18:29Z", "content_hash": "060d08c5c1626d69ef98a2a2c898fc4c45a5c06d3fa4fdc38aa6c4ee4fc2cda6", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:pubmed-10-1016-s0140-6736-24-01749-5", "source_type": "publication", "title": "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", "canonical_url": "https://doi.org/10.1016/S0140-6736(24)01749-5", "identifiers": [ { "scheme": "doi", "value": "10.1016/S0140-6736(24)01749-5", "normalized_value": "10.1016/s0140-6736(24)01749-5", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "pmid", "value": "39461792", "normalized_value": "39461792", "match": "exact", "version": null, "label": null, "from_source": false } ], "publication_date": "2024-10-26", "publisher": "Lancet (London, England)", "edition": "PubMed record (abstract and bibliographic data) from NCBI E-utilities. 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The full text and the version of record were not fetched.", "reuse_basis": "PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). 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The full text and the version of record were not fetched.", "reuse_basis": "PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). 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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.", "context": { "id": "maternal:ctx-who-2025-pph-txa-prevention-vaginal-birth", "label": "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_note": "Childbirth, before significant bleeding", "life_stage_terms": { "maternal": [ "childbirth" ] }, "gestational_age_min_days": null, "gestational_age_max_days": null, "gestational_age_basis": null, "postnatal_age_min_days": null, "postnatal_age_max_days": null, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "Not applicable (recommendation context)", "eligibility": { "inclusion": [ "Women at vaginal birth" ], "exclusion": [ "Women who already have postpartum haemorrhage (treatment is a separate recommendation)" ] } }, "evidence_stage": "guidance", "certainty": "not_assessed", "certainty_method": null, "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.", "editorial_state": "draft", "checked_at": "2026-10-15", "next_review_due": null, "valid_from": null, "valid_to": null, "citations": [ { "evidence_role": "supports", "locator": "Recommendation 14: text, category and justification (vaginal birth)", "applicability_note": "WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution.", "snapshot": { "id": "maternal:who-9789240115637-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:12:00Z", "content_hash": "2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2025-pph-consolidated", "source_type": "guideline", "title": "Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage", "canonical_url": "https://www.who.int/publications/i/item/9789240115637", "identifiers": [ { "scheme": "isbn", "value": "978-92-4-011563-7", "normalized_value": "9789240115637", "match": "exact", "version": null, "label": null, "from_source": false } ], "publication_date": "2025-10-05", "publisher": "World Health Organization, co-published with the International Federation of Gynecology and Obstetrics (FIGO) and the International Confederation of Midwives (ICM)", "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.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF and in the IRIS record. Only short quotations with attribution are used, and neither the PDF nor the pages are committed. 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The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Recommendation 14, Remarks: treatment stays recommended", "applicability_note": "WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution.", "snapshot": { "id": "maternal:who-9789240115637-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:12:00Z", "content_hash": "2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2025-pph-consolidated", "source_type": "guideline", "title": "Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage", "canonical_url": "https://www.who.int/publications/i/item/9789240115637", "identifiers": [ { "scheme": "isbn", "value": "978-92-4-011563-7", "normalized_value": "9789240115637", "match": "exact", "version": null, "label": null, "from_source": false } ], "publication_date": "2025-10-05", "publisher": "World Health Organization, co-published with the International Federation of Gynecology and Obstetrics (FIGO) and the International Confederation of Midwives (ICM)", "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.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF and in the IRIS record. Only short quotations with attribution are used, and neither the PDF nor the pages are committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote" } } ], "review": { "content_digest": "e3d7d863ff3e0d06655a1af8b76eda889e725ee07d1f138f9255863c2cf42db0", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "api_path": "api/v1/claims/maternal--claim-who-2025-pph-14-txa-prevention-vaginal-birth.json" }, { "release_id": "c7fb95f1d15a7d13", "id": "maternal:claim-who-2025-pph-15-txa-prevention-caesarean-birth", "owner": "maternal", "subject_entity_id": "maternal:tranexamic-acid-pph-prevention", "category": "recommendation", "statement": "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.", "context": { "id": "maternal:ctx-who-2025-pph-txa-prevention-caesarean-birth", "label": "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_note": "Childbirth, before significant bleeding", "life_stage_terms": { "maternal": [ "childbirth" ] }, "gestational_age_min_days": null, "gestational_age_max_days": null, "gestational_age_basis": null, "postnatal_age_min_days": null, "postnatal_age_max_days": null, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "Not applicable (recommendation context)", "eligibility": { "inclusion": [ "Women at caesarean birth" ], "exclusion": [ "Women who already have postpartum haemorrhage (treatment is a separate recommendation)" ] } }, "evidence_stage": "guidance", "certainty": "not_assessed", "certainty_method": null, "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. 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