Tranexamic acid for treating postpartum haemorrhage
A medicine given into a vein, on top of usual care, to women who are bleeding heavily after birth. It works by slowing the breakdown of blood clots. In the WOMAN trial it lowered deaths from bleeding but did not clearly change deaths from all causes or hysterectomy. WHO recommends giving it early, within 3 hours of birth. This page is about treating bleeding that has started. WHO 2025 does not recommend the medicine to prevent bleeding in women who are not bleeding heavily.
Also called TXA for PPH treatment · Tranexamic acid
- Intervention
- In this atlas
Overview
Technical summary
Added to standard care as 1 g (100 mg/mL) intravenously at 1 mL per minute, with a second 1 g dose if bleeding continues after 30 minutes or restarts within 24 hours, as in WOMAN and as supported by WHO 2025 Recommendation 27. The overall WOMAN result covers all treatment times; the within-3-hours result is a pre-specified subgroup with its own claim and context. WHO 2025 Recommendations 14 and 15 do not recommend it for prevention at vaginal or caesarean birth; that is a different use with its own claim and context, and treatment evidence does not transfer to it. No treats relationship is recorded: the claims and the WHO recommendation say what is known, and a clinical reviewer can decide whether a stronger link is warranted.
About this intervention
- Type
- Medicine
- Mechanism
- Inhibits the enzymatic breakdown of fibrinogen and fibrin by plasmin (WOMAN introduction).
Claims and evidence
Context Women aged 16 or older with clinically diagnosed postpartum haemorrhage after vaginal or caesarean birth, in 193 hospitals in 21 countries (WOMAN)
- Recipient
- Maternal
- Population
- Women aged 16 years and older with a clinical diagnosis of postpartum haemorrhage after a vaginal birth or caesarean section. WOMAN specified that the diagnosis could rest on clinically estimated blood loss of more than 500 mL after vaginal birth or 1000 mL after caesarean section, or any blood loss sufficient to compromise haemodynamic stability. This is the trial eligibility wording, not a WHO definition. The fundamental eligibility criterion was the clinician uncertainty about whether to use tranexamic acid in that woman. The overall result covers every treatment time.
- Care setting
- Hospitals (193 in the paper).
- Geography
- Hospitals in 21 countries. The paper site list names Nigeria, Pakistan, Uganda, Kenya, Cameroon, Sudan, United Kingdom, Tanzania, Nepal, Zambia, Albania, Democratic Republic of Congo, Bangladesh, Ethiopia, Burkina Faso, Jamaica, Ghana, Papua New Guinea, Egypt, Colombia and Cote d'Ivoire.
- Life stage
- Postpartum, treated within hours of birth or later
- Gestational age
- Not reported
- Postnatal age
- Not reported
- Follow-up
- Outcome data were collected at death, discharge or 42 days after randomisation, whichever came first.
Eligibility: 3 inclusion criteria; 3 exclusion criteria
- Included
- Aged 16 years or older
- Clinical diagnosis of postpartum haemorrhage after vaginal birth or caesarean section
- Responsible clinician uncertain whether to use tranexamic acid for this woman
- Excluded
- The registry (ISRCTN) lists a clear indication for antifibrinolytic therapy, as judged by the responsible doctor
- The registry (ISRCTN) lists a clear contraindication to antifibrinolytic therapy
- The paper text gives no other exclusion criteria
In WOMAN, 227 women given tranexamic acid (2.3%) and 256 given placebo (2.6%) died from any cause, a risk ratio of 0.88 (95% CI 0.74 to 1.05, p=0.16). The difference was not statistically significant. The authors note that more than a quarter of deaths were not due to bleeding, which dilutes any effect on all-cause death, and that the effect on death due to bleeding is the more generalisable measure.
Source problem. A cited source is corrected. Check the sources before relying on this claim.
Applies to Maternal- Women aged 16 years and older with a clinical diagnosis of postpartum haemorrhage after a vaginal birth or caesarean section. WOMAN specified that the diagnosis could rest on clinically estimated blood loss of more than 500 mL after vaginal birth or 1000 mL after caesarean section, or any blood loss sufficient to compromise haemodynamic stability. This is the trial eligibility wording, not a WHO definition. The fundamental eligibility criterion was the clinician uncertainty about whether to use tranexamic acid in that woman. The overall result covers every treatment time.
- Hospitals (193 in the paper).
- Hospitals in 21 countries. The paper site list names Nigeria, Pakistan, Uganda, Kenya, Cameroon, Sudan, United Kingdom, Tanzania, Nepal, Zambia, Albania, Democratic Republic of Congo, Bangladesh, Ethiopia, Burkina Faso, Jamaica, Ghana, Papua New Guinea, Egypt, Colombia and Cote d'Ivoire.
- Postpartum, treated within hours of birth or later
- Gestational age Not reported
- Postnatal age Not reported
- Certainty method
- Not assessed
- Limitations
- All-cause death was assessed separately from the primary composite and is not named as a secondary outcome in the methods, so its endpoint role is not specified. The mix of bleeding and non-bleeding deaths varies by region and hospital, so the authors say the all-cause effect is not generalisable. Denominators are 10 036 and 9985 as printed, and the paper prints no total. Source correction: the Lancet printed a correction to this paper (a Department of Error notice; the online article was corrected on 5 May 2017). It changes one number in the procedures section, the tranexamic acid concentration, from 10 mg/mL to 100 mg/mL. The correction notice lists this one change and no other, and the text read for this claim is the corrected text. The source state shows Corrected for that reason.
- Last checked
- 2026-10-11
- Next evidence check due
- Not scheduled
Sources and citations (3)
-
- Locator
- Results, Maternal death, para 1: all-cause death 227 and 256, risk ratio 0.88
- How it applies
- Open-access version of record (CC BY-NC-ND 4.0), which carries the online correction of 5 May 2017.
- Retrieved
- Source effective date
- Not reported
- Source state
- Corrected
- Snapshot hash
6a76b2d6a645ab133480bc533cf223870f0d4759de632b12b704fcf261daffe4- Reuse basis
- PMC5446563 is open access under CC BY-NC-ND 4.0, as its own XML states. Short factual extraction and short quotations with attribution (WOMAN Trial Collaborators, Lancet 2017;389:2105-2116, doi:10.1016/S0140-6736(17)30638-4); no adaptation. The XML is not committed because of the non-commercial term; only its sha256 is kept. The PubMed record is not committed either. The Figure 3 image (gr3.jpg from the PMC figure page, same licence) is not committed; only its sha256 is kept, and its numbers were read from the image by eye.
-
- Locator
- Discussion, para 2: why all-cause death is diluted
- How it applies
- The authors own reading of the result.
- Retrieved
- Source effective date
- Not reported
- Source state
- Corrected
- Snapshot hash
6a76b2d6a645ab133480bc533cf223870f0d4759de632b12b704fcf261daffe4- Reuse basis
- PMC5446563 is open access under CC BY-NC-ND 4.0, as its own XML states. Short factual extraction and short quotations with attribution (WOMAN Trial Collaborators, Lancet 2017;389:2105-2116, doi:10.1016/S0140-6736(17)30638-4); no adaptation. The XML is not committed because of the non-commercial term; only its sha256 is kept. The PubMed record is not committed either. The Figure 3 image (gr3.jpg from the PMC figure page, same licence) is not committed; only its sha256 is kept, and its numbers were read from the image by eye.
-
Background Department of Error (correction to the WOMAN trial report)
- Locator
- Erratum text: tranexamic acid concentration corrected in the procedures section
- How it applies
- The correction changes a drug concentration, not a result.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
4d208f181f5cdbc06acf1817fcc38b5c0f1aa32848784237eed45c1e13fbbf6d- Reuse basis
- PMC6891225 is open access under CC BY-NC-ND 4.0, as its own XML states. Short quotation with attribution; the XML is not committed.
The primary outcome of WOMAN was death from any cause or hysterectomy within 42 days, counted in the methods from randomisation. Tranexamic acid did not clearly reduce it. 534 women in the tranexamic acid group and 546 in the placebo group had the outcome, a risk ratio of 0.97 (95% CI 0.87 to 1.09, p=0.65). Hysterectomy alone was also not reduced (358 with tranexamic acid and 351 with placebo, risk ratio 1.02, 95% CI 0.88 to 1.07 as printed, p=0.84). The fewer deaths from bleeding seen in this trial did not show up in this combined outcome.
Source problem. A cited source is corrected. Check the sources before relying on this claim.
Applies to Maternal- Women aged 16 years and older with a clinical diagnosis of postpartum haemorrhage after a vaginal birth or caesarean section. WOMAN specified that the diagnosis could rest on clinically estimated blood loss of more than 500 mL after vaginal birth or 1000 mL after caesarean section, or any blood loss sufficient to compromise haemodynamic stability. This is the trial eligibility wording, not a WHO definition. The fundamental eligibility criterion was the clinician uncertainty about whether to use tranexamic acid in that woman. The overall result covers every treatment time.
- Hospitals (193 in the paper).
- Hospitals in 21 countries. The paper site list names Nigeria, Pakistan, Uganda, Kenya, Cameroon, Sudan, United Kingdom, Tanzania, Nepal, Zambia, Albania, Democratic Republic of Congo, Bangladesh, Ethiopia, Burkina Faso, Jamaica, Ghana, Papua New Guinea, Egypt, Colombia and Cote d'Ivoire.
- Postpartum, treated within hours of birth or later
- Gestational age Not reported
- Postnatal age Not reported
- Certainty method
- Not assessed
- Limitations
- The composite joins death with hysterectomy. The authors expected hysterectomy decisions made at the time of randomisation to dilute any effect on hysterectomy. No composite outcome record exists in this atlas, so no finding rows are entered, and this composite is never placed on the all-cause death outcome. The printed placebo percentage differs between the abstract (5.5%) and the results text (5.6%) and is not used. The hysterectomy interval is printed identically in the abstract and the results text as 0.88 to 1.07 around a ratio of 1.02, which is not symmetric; it is recorded as printed and was not recomputed, and the table itself was not located. The denominators printed for the composite are 10 032 (tranexamic acid, Table 3) and 9985 (placebo). Source correction: the Lancet printed a correction to this paper (a Department of Error notice; the online article was corrected on 5 May 2017). It changes one number in the procedures section, the tranexamic acid concentration, from 10 mg/mL to 100 mg/mL. The correction notice lists this one change and no other, and the text read for this claim is the corrected text. The source state shows Corrected for that reason.
- Last checked
- 2026-10-11
- Next evidence check due
- Not scheduled
Sources and citations (7)
-
- Locator
- Results, Primary endpoint, para 1: 534 and 546, risk ratio 0.97
- How it applies
- Open-access version of record (CC BY-NC-ND 4.0), which carries the online correction of 5 May 2017.
- Retrieved
- Source effective date
- Not reported
- Source state
- Corrected
- Snapshot hash
6a76b2d6a645ab133480bc533cf223870f0d4759de632b12b704fcf261daffe4- Reuse basis
- PMC5446563 is open access under CC BY-NC-ND 4.0, as its own XML states. Short factual extraction and short quotations with attribution (WOMAN Trial Collaborators, Lancet 2017;389:2105-2116, doi:10.1016/S0140-6736(17)30638-4); no adaptation. The XML is not committed because of the non-commercial term; only its sha256 is kept. The PubMed record is not committed either. The Figure 3 image (gr3.jpg from the PMC figure page, same licence) is not committed; only its sha256 is kept, and its numbers were read from the image by eye.
-
- Locator
- Abstract, Findings, sentence 5: composite primary endpoint not reduced
- How it applies
- PubMed abstract; the placebo percentage differs from the results text.
- Retrieved
- Source effective date
- Not reported
- Source state
- Corrected
- Snapshot hash
e734360d2becdd1091cac4214a571195ec245318bbcc57203b4aefce56222f3a- Reuse basis
- PMC5446563 is open access under CC BY-NC-ND 4.0, as its own XML states. Short factual extraction and short quotations with attribution (WOMAN Trial Collaborators, Lancet 2017;389:2105-2116, doi:10.1016/S0140-6736(17)30638-4); no adaptation. The XML is not committed because of the non-commercial term; only its sha256 is kept. The PubMed record is not committed either. The Figure 3 image (gr3.jpg from the PMC figure page, same licence) is not committed; only its sha256 is kept, and its numbers were read from the image by eye.
-
- Locator
- Results, Hysterectomy, para 1: 358 and 351, risk ratio 1.02
- How it applies
- Interval recorded as printed.
- Retrieved
- Source effective date
- Not reported
- Source state
- Corrected
- Snapshot hash
6a76b2d6a645ab133480bc533cf223870f0d4759de632b12b704fcf261daffe4- Reuse basis
- PMC5446563 is open access under CC BY-NC-ND 4.0, as its own XML states. Short factual extraction and short quotations with attribution (WOMAN Trial Collaborators, Lancet 2017;389:2105-2116, doi:10.1016/S0140-6736(17)30638-4); no adaptation. The XML is not committed because of the non-commercial term; only its sha256 is kept. The PubMed record is not committed either. The Figure 3 image (gr3.jpg from the PMC figure page, same licence) is not committed; only its sha256 is kept, and its numbers were read from the image by eye.
-
- Locator
- Abstract, Findings, sentence 4: hysterectomy not reduced
- How it applies
- The same interval is printed in the abstract.
- Retrieved
- Source effective date
- Not reported
- Source state
- Corrected
- Snapshot hash
e734360d2becdd1091cac4214a571195ec245318bbcc57203b4aefce56222f3a- Reuse basis
- PMC5446563 is open access under CC BY-NC-ND 4.0, as its own XML states. Short factual extraction and short quotations with attribution (WOMAN Trial Collaborators, Lancet 2017;389:2105-2116, doi:10.1016/S0140-6736(17)30638-4); no adaptation. The XML is not committed because of the non-commercial term; only its sha256 is kept. The PubMed record is not committed either. The Figure 3 image (gr3.jpg from the PMC figure page, same licence) is not committed; only its sha256 is kept, and its numbers were read from the image by eye.
-
- Locator
- Methods, Outcomes, para 1: primary outcome definition
- How it applies
- Defines the composite and its 42-day window.
- Retrieved
- Source effective date
- Not reported
- Source state
- Corrected
- Snapshot hash
6a76b2d6a645ab133480bc533cf223870f0d4759de632b12b704fcf261daffe4- Reuse basis
- PMC5446563 is open access under CC BY-NC-ND 4.0, as its own XML states. Short factual extraction and short quotations with attribution (WOMAN Trial Collaborators, Lancet 2017;389:2105-2116, doi:10.1016/S0140-6736(17)30638-4); no adaptation. The XML is not committed because of the non-commercial term; only its sha256 is kept. The PubMed record is not committed either. The Figure 3 image (gr3.jpg from the PMC figure page, same licence) is not committed; only its sha256 is kept, and its numbers were read from the image by eye.
-
- Locator
- Table 3, row All patients: denominators 10 032 and 9985
- How it applies
- Denominators as printed; never summed.
- Retrieved
- Source effective date
- Not reported
- Source state
- Corrected
- Snapshot hash
6a76b2d6a645ab133480bc533cf223870f0d4759de632b12b704fcf261daffe4- Reuse basis
- PMC5446563 is open access under CC BY-NC-ND 4.0, as its own XML states. Short factual extraction and short quotations with attribution (WOMAN Trial Collaborators, Lancet 2017;389:2105-2116, doi:10.1016/S0140-6736(17)30638-4); no adaptation. The XML is not committed because of the non-commercial term; only its sha256 is kept. The PubMed record is not committed either. The Figure 3 image (gr3.jpg from the PMC figure page, same licence) is not committed; only its sha256 is kept, and its numbers were read from the image by eye.
-
Background Department of Error (correction to the WOMAN trial report)
- Locator
- Erratum text: tranexamic acid concentration corrected in the procedures section
- How it applies
- The correction changes a drug concentration, not a result.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
4d208f181f5cdbc06acf1817fcc38b5c0f1aa32848784237eed45c1e13fbbf6d- Reuse basis
- PMC6891225 is open access under CC BY-NC-ND 4.0, as its own XML states. Short quotation with attribution; the XML is not committed.
In the WOMAN trial, women with heavy bleeding after birth who were given tranexamic acid were less likely to die of bleeding than women given a placebo. 155 of 10 036 women (1.5%) died of bleeding with tranexamic acid, against 191 of 9985 (1.9%) with placebo. The risk ratio was 0.81 (95% confidence interval 0.65 to 1.00, p=0.045). The authors named death due to bleeding as the key secondary outcome. The upper end of the interval touches 1.00, and the primary outcome, death from any cause or hysterectomy, did not differ clearly between the groups (separate claim).
Source problem. A cited source is corrected. Check the sources before relying on this claim.
Applies to Maternal- Women aged 16 years and older with a clinical diagnosis of postpartum haemorrhage after a vaginal birth or caesarean section. WOMAN specified that the diagnosis could rest on clinically estimated blood loss of more than 500 mL after vaginal birth or 1000 mL after caesarean section, or any blood loss sufficient to compromise haemodynamic stability. This is the trial eligibility wording, not a WHO definition. The fundamental eligibility criterion was the clinician uncertainty about whether to use tranexamic acid in that woman. The overall result covers every treatment time.
- Hospitals (193 in the paper).
- Hospitals in 21 countries. The paper site list names Nigeria, Pakistan, Uganda, Kenya, Cameroon, Sudan, United Kingdom, Tanzania, Nepal, Zambia, Albania, Democratic Republic of Congo, Bangladesh, Ethiopia, Burkina Faso, Jamaica, Ghana, Papua New Guinea, Egypt, Colombia and Cote d'Ivoire.
- Postpartum, treated within hours of birth or later
- Gestational age Not reported
- Postnatal age Not reported
- Certainty method
- Not assessed
- Limitations
- Death due to bleeding is a cause-specific secondary outcome. The primary composite showed no clear difference. The upper confidence bound is 1.00. The planned sample of 15 000 was raised to 20 000 during the trial to estimate this effect, after hysterectomy decisions were found to be often made at the time of randomisation. The authors state that they pre-specified this outcome and the time-to-treatment subgroups before un-blinding. Clinicians recorded the immediate cause of death, the main cause if there were several. The trial was double-blind. The paper also gives an adjusted risk ratio of 0.78 (95% CI 0.62 to 0.98). Adverse events, including thromboembolic events, did not differ significantly between groups in WOMAN. Pfizer is among the funders and made the trial drug. Analysed numbers are those printed for this analysis (10 036 and 9985); some randomised women were excluded from analysis and the paper prints no total. Source correction: the Lancet printed a correction to this paper (a Department of Error notice; the online article was corrected on 5 May 2017). It changes one number in the procedures section, the tranexamic acid concentration, from 10 mg/mL to 100 mg/mL. The correction notice lists this one change and no other, and the text read for this claim is the corrected text. The source state shows Corrected for that reason.
- Last checked
- 2026-10-11
- Next evidence check due
- Not scheduled
Sources and citations (6)
-
- Locator
- Results, Maternal death, para 1: bleeding deaths 155 and 191, risk ratio 0.81
- How it applies
- Open-access version of record (CC BY-NC-ND 4.0), which carries the online correction of 5 May 2017.
- Retrieved
- Source effective date
- Not reported
- Source state
- Corrected
- Snapshot hash
6a76b2d6a645ab133480bc533cf223870f0d4759de632b12b704fcf261daffe4- Reuse basis
- PMC5446563 is open access under CC BY-NC-ND 4.0, as its own XML states. Short factual extraction and short quotations with attribution (WOMAN Trial Collaborators, Lancet 2017;389:2105-2116, doi:10.1016/S0140-6736(17)30638-4); no adaptation. The XML is not committed because of the non-commercial term; only its sha256 is kept. The PubMed record is not committed either. The Figure 3 image (gr3.jpg from the PMC figure page, same licence) is not committed; only its sha256 is kept, and its numbers were read from the image by eye.
-
- Locator
- Abstract, Findings, sentence 2: death due to bleeding significantly reduced
- How it applies
- PubMed abstract of the same report.
- Retrieved
- Source effective date
- Not reported
- Source state
- Corrected
- Snapshot hash
e734360d2becdd1091cac4214a571195ec245318bbcc57203b4aefce56222f3a- Reuse basis
- PMC5446563 is open access under CC BY-NC-ND 4.0, as its own XML states. Short factual extraction and short quotations with attribution (WOMAN Trial Collaborators, Lancet 2017;389:2105-2116, doi:10.1016/S0140-6736(17)30638-4); no adaptation. The XML is not committed because of the non-commercial term; only its sha256 is kept. The PubMed record is not committed either. The Figure 3 image (gr3.jpg from the PMC figure page, same licence) is not committed; only its sha256 is kept, and its numbers were read from the image by eye.
-
- Locator
- Methods, Outcomes, para 1: death due to bleeding as the key secondary outcome
- How it applies
- Establishes the outcome role.
- Retrieved
- Source effective date
- Not reported
- Source state
- Corrected
- Snapshot hash
6a76b2d6a645ab133480bc533cf223870f0d4759de632b12b704fcf261daffe4- Reuse basis
- PMC5446563 is open access under CC BY-NC-ND 4.0, as its own XML states. Short factual extraction and short quotations with attribution (WOMAN Trial Collaborators, Lancet 2017;389:2105-2116, doi:10.1016/S0140-6736(17)30638-4); no adaptation. The XML is not committed because of the non-commercial term; only its sha256 is kept. The PubMed record is not committed either. The Figure 3 image (gr3.jpg from the PMC figure page, same licence) is not committed; only its sha256 is kept, and its numbers were read from the image by eye.
-
- Locator
- Methods, Statistical analysis, para 1: sample size increase and pre-specification before un-blinding
- How it applies
- Explains why this outcome was added and when.
- Retrieved
- Source effective date
- Not reported
- Source state
- Corrected
- Snapshot hash
6a76b2d6a645ab133480bc533cf223870f0d4759de632b12b704fcf261daffe4- Reuse basis
- PMC5446563 is open access under CC BY-NC-ND 4.0, as its own XML states. Short factual extraction and short quotations with attribution (WOMAN Trial Collaborators, Lancet 2017;389:2105-2116, doi:10.1016/S0140-6736(17)30638-4); no adaptation. The XML is not committed because of the non-commercial term; only its sha256 is kept. The PubMed record is not committed either. The Figure 3 image (gr3.jpg from the PMC figure page, same licence) is not committed; only its sha256 is kept, and its numbers were read from the image by eye.
-
- Locator
- Summary, Findings: adverse events did not differ significantly
- How it applies
- Safety context from the same trial.
- Retrieved
- Source effective date
- Not reported
- Source state
- Corrected
- Snapshot hash
6a76b2d6a645ab133480bc533cf223870f0d4759de632b12b704fcf261daffe4- Reuse basis
- PMC5446563 is open access under CC BY-NC-ND 4.0, as its own XML states. Short factual extraction and short quotations with attribution (WOMAN Trial Collaborators, Lancet 2017;389:2105-2116, doi:10.1016/S0140-6736(17)30638-4); no adaptation. The XML is not committed because of the non-commercial term; only its sha256 is kept. The PubMed record is not committed either. The Figure 3 image (gr3.jpg from the PMC figure page, same licence) is not committed; only its sha256 is kept, and its numbers were read from the image by eye.
-
Background Department of Error (correction to the WOMAN trial report)
- Locator
- Erratum text: tranexamic acid concentration corrected in the procedures section
- How it applies
- The correction changes a drug concentration, not a result.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
4d208f181f5cdbc06acf1817fcc38b5c0f1aa32848784237eed45c1e13fbbf6d- Reuse basis
- PMC6891225 is open access under CC BY-NC-ND 4.0, as its own XML states. Short quotation with attribution; the XML is not committed.
Context Women at vaginal or caesarean birth who are not yet bleeding enough to meet the PPH criteria (WHO 2025 Recommendations 14 and 15, prevention)
- Recipient
- Maternal
- Population
- Women at vaginal birth (Recommendation 14) or caesarean birth (Recommendation 15), 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 says the recommendations apply at the population level to all such births.
- 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)
Eligibility: 2 inclusion criteria; 1 exclusion criterion
- Included
- Women at vaginal birth
- Women at caesarean birth
- Excluded
- Women who already have postpartum haemorrhage (treatment is a separate recommendation)
This claim is about prevention, a different use from the treatment that this page describes. The 2025 WHO consolidated guideline does not recommend tranexamic acid to prevent postpartum haemorrhage, either at vaginal birth (Recommendation 14) or at caesarean birth (Recommendation 15). Both are new and fall in the category Not recommended. WHO gives its own reasons for each. For Recommendation 14, the medicine showed no clinical benefit over standard preventive measures in reducing PPH, and a modest increase in clot-related events could not be confidently ruled out. For Recommendation 15, it found no additional benefit in reducing blood loss. WHO saw no clear increase in life-threatening adverse events, but said a small but clinically important increase in clot-related (thromboembolic) risk could not be ruled out, which is particularly relevant during caesarean birth when the baseline risk of clots is higher. Tranexamic acid stays recommended for treating PPH (Recommendations 27 and 29). For certain high-risk women at caesarean birth, WHO says clinicians could consider it to control bleeding even before the diagnostic criteria are met.
Applies to Maternal- Women at vaginal birth (Recommendation 14) or caesarean birth (Recommendation 15), 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 says the recommendations apply at the population level to all such births.
- Not stated in the source
- Global (WHO guidance intended to inform national and subnational policy).
- Childbirth, before significant bleeding
- Gestational age Not reported
- Postnatal age Not reported
- Certainty method
- Not assessed
- Limitations
- Claim only, with no relationship and no decision row. The only intervention record in this atlas is the treatment record, and a decision against would sit beside a recommendation for the same record. A separate prevention intervention could carry both Not recommended recommendations as decisions. WHO says the recommendations apply at the population level to all such births and depend on the capacity to accurately assess blood loss. The evidence for these two recommendations (Web Annex A) was not read. WOMAN studied women who were already bleeding and is not evidence for this claim. WHO 2025 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.
- Last checked
- 2026-10-12
- Next evidence check due
- Not scheduled
Sources and citations (4)
-
Supports Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage
- Locator
- Recommendation 14: text, category and justification (vaginal birth)
- How it applies
- WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de- 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.
-
Supports Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage
- Locator
- Recommendation 15: text, category and justification (caesarean birth)
- How it applies
- WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de- 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.
-
Background Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage
- Locator
- Recommendation 14, Remarks: treatment stays recommended; population-level scope
- How it applies
- WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de- 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.
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Background Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage
- Locator
- Recommendation 15, Remarks, bullet 3: clinical judgement for high-risk women
- How it applies
- WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de- 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.
Context Women in WOMAN who received the trial treatment within 3 hours of giving birth (pre-specified subgroup)
- Recipient
- Maternal
- Population
- The subgroup of WOMAN women treated within 3 hours of giving birth. The trial pre-specified subgroup analyses of death due to bleeding by the time interval between giving birth and treatment, as a protocol change made before un-blinding. The same eligibility applies as for the whole trial. The comparison with later treatment is given in the same claim.
- Care setting
- Hospitals (193 in the paper).
- Geography
- Hospitals in 21 countries, as for the whole trial.
- Life stage
- Postpartum, within 3 hours of birth
- Gestational age
- Not reported
- Postnatal age
- Not reported
- Follow-up
- Outcome data were collected at death, discharge or 42 days after randomisation, whichever came first.
Eligibility: 2 inclusion criteria; 1 exclusion criterion
- Included
- WOMAN-eligible woman
- Treatment started within 3 hours of giving birth
- Excluded
- Women treated more than 3 hours after birth are the comparison subgroup, not part of this context
Among women in WOMAN who were given tranexamic acid within 3 hours of giving birth, 89 died of bleeding against 127 given placebo, a risk ratio of 0.69 (95% CI 0.52 to 0.91, p=0.008). When treatment came after 3 hours the counts were 66 and 63, a risk ratio of 1.07 (95% CI 0.76 to 1.51, p=0.70). This is a pre-specified subgroup analysis of the secondary outcome, not the primary result. The trial stated its own rule. Unless the test for different effects across subgroups gave p below 0.001, the overall relative risk (0.81 for death due to bleeding) was regarded as the most reliable guide to subgroup effects. Figure 3 of the paper gives p=0.085 for the test of different effects across the three time-from-delivery groups (up to 1 hour, over 1 to 3 hours, over 3 hours). That is above the trial bar of 0.001, so by the trial rule the overall relative risk of 0.81 stays the better guide. Because earlier trauma data gave strong reason to expect a time effect, the authors also planned to read the timing result alongside all available data on that effect.
Source problem. A cited source is corrected. Check the sources before relying on this claim.
Applies to Maternal- The subgroup of WOMAN women treated within 3 hours of giving birth. The trial pre-specified subgroup analyses of death due to bleeding by the time interval between giving birth and treatment, as a protocol change made before un-blinding. The same eligibility applies as for the whole trial. The comparison with later treatment is given in the same claim.
- Hospitals (193 in the paper).
- Hospitals in 21 countries, as for the whole trial.
- Postpartum, within 3 hours of birth
- Gestational age Not reported
- Postnatal age Not reported
- Certainty method
- Not assessed
- Limitations
- The p=0.085 in Figure 3 tests three time groups together, not the within-3-hours split alone, and the paper text gives no heterogeneity result for time to treatment on this outcome. Figure 5 of the paper sets WOMAN beside CRASH-2 results and has its own heterogeneity p value; this record did not read it. Figure 3 prints separate denominators for the up to 1 hour and over 1 to 3 hours groups and no combined within-3-hours denominator. WHO 2025 Recommendation 27 remarks rest the 3-hour window on WOMAN timing analysis and on a pooled individual-participant analysis of 40 138 bleeding patients, which includes WOMAN participants and trauma patients. Death due to bleeding is a cause-specific secondary outcome and the primary composite was not clearly reduced. Source correction: the Lancet printed a correction to this paper (a Department of Error notice; the online article was corrected on 5 May 2017). It changes one number in the procedures section, the tranexamic acid concentration, from 10 mg/mL to 100 mg/mL. The correction notice lists this one change and no other, and the text read for this claim is the corrected text. The source state shows Corrected for that reason.
- Last checked
- 2026-10-12
- Next evidence check due
- Not scheduled
Sources and citations (8)
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- Locator
- Results, Maternal death, para 3: 89 and 127 within 3 hours; 66 and 63 after 3 hours
- How it applies
- Open-access version of record (CC BY-NC-ND 4.0), which carries the online correction of 5 May 2017.
- Retrieved
- Source effective date
- Not reported
- Source state
- Corrected
- Snapshot hash
6a76b2d6a645ab133480bc533cf223870f0d4759de632b12b704fcf261daffe4- Reuse basis
- PMC5446563 is open access under CC BY-NC-ND 4.0, as its own XML states. Short factual extraction and short quotations with attribution (WOMAN Trial Collaborators, Lancet 2017;389:2105-2116, doi:10.1016/S0140-6736(17)30638-4); no adaptation. The XML is not committed because of the non-commercial term; only its sha256 is kept. The PubMed record is not committed either. The Figure 3 image (gr3.jpg from the PMC figure page, same licence) is not committed; only its sha256 is kept, and its numbers were read from the image by eye.
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- Locator
- Abstract, Findings, sentence 2: especially within 3 hours of giving birth
- How it applies
- PubMed abstract of the same report.
- Retrieved
- Source effective date
- Not reported
- Source state
- Corrected
- Snapshot hash
e734360d2becdd1091cac4214a571195ec245318bbcc57203b4aefce56222f3a- Reuse basis
- PMC5446563 is open access under CC BY-NC-ND 4.0, as its own XML states. Short factual extraction and short quotations with attribution (WOMAN Trial Collaborators, Lancet 2017;389:2105-2116, doi:10.1016/S0140-6736(17)30638-4); no adaptation. The XML is not committed because of the non-commercial term; only its sha256 is kept. The PubMed record is not committed either. The Figure 3 image (gr3.jpg from the PMC figure page, same licence) is not committed; only its sha256 is kept, and its numbers were read from the image by eye.
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- Locator
- Methods, Statistical analysis, para 3: homogeneity rule and overall relative risk
- How it applies
- The trial own rule for reading subgroups.
- Retrieved
- Source effective date
- Not reported
- Source state
- Corrected
- Snapshot hash
6a76b2d6a645ab133480bc533cf223870f0d4759de632b12b704fcf261daffe4- Reuse basis
- PMC5446563 is open access under CC BY-NC-ND 4.0, as its own XML states. Short factual extraction and short quotations with attribution (WOMAN Trial Collaborators, Lancet 2017;389:2105-2116, doi:10.1016/S0140-6736(17)30638-4); no adaptation. The XML is not committed because of the non-commercial term; only its sha256 is kept. The PubMed record is not committed either. The Figure 3 image (gr3.jpg from the PMC figure page, same licence) is not committed; only its sha256 is kept, and its numbers were read from the image by eye.
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- Locator
- Figure 3 image, Time from delivery (h) block: group counts and the heterogeneity p value
- How it applies
- Figure image on the PMC figure page of the open-access version of record (CC BY-NC-ND 4.0), read by eye; the numbers are not in the XML.
- Retrieved
- Source effective date
- Not reported
- Source state
- Corrected
- Snapshot hash
fe0cb41cfd6fbcbb55fc2536569de36ed1641ca9ce90f4310ef13db7d5241fcc- Reuse basis
- PMC5446563 is open access under CC BY-NC-ND 4.0, as its own XML states. Short factual extraction and short quotations with attribution (WOMAN Trial Collaborators, Lancet 2017;389:2105-2116, doi:10.1016/S0140-6736(17)30638-4); no adaptation. The XML is not committed because of the non-commercial term; only its sha256 is kept. The PubMed record is not committed either. The Figure 3 image (gr3.jpg from the PMC figure page, same licence) is not committed; only its sha256 is kept, and its numbers were read from the image by eye.
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- Locator
- Results, Maternal death, Figure 3 caption: the asterisk marks the heterogeneity p value
- How it applies
- Caption of the figure that holds the time-to-treatment test.
- Retrieved
- Source effective date
- Not reported
- Source state
- Corrected
- Snapshot hash
6a76b2d6a645ab133480bc533cf223870f0d4759de632b12b704fcf261daffe4- Reuse basis
- PMC5446563 is open access under CC BY-NC-ND 4.0, as its own XML states. Short factual extraction and short quotations with attribution (WOMAN Trial Collaborators, Lancet 2017;389:2105-2116, doi:10.1016/S0140-6736(17)30638-4); no adaptation. The XML is not committed because of the non-commercial term; only its sha256 is kept. The PubMed record is not committed either. The Figure 3 image (gr3.jpg from the PMC figure page, same licence) is not committed; only its sha256 is kept, and its numbers were read from the image by eye.
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- Locator
- Methods, Statistical analysis, para 1: subgroup pre-specified before un-blinding
- How it applies
- Timing of the pre-specification.
- Retrieved
- Source effective date
- Not reported
- Source state
- Corrected
- Snapshot hash
6a76b2d6a645ab133480bc533cf223870f0d4759de632b12b704fcf261daffe4- Reuse basis
- PMC5446563 is open access under CC BY-NC-ND 4.0, as its own XML states. Short factual extraction and short quotations with attribution (WOMAN Trial Collaborators, Lancet 2017;389:2105-2116, doi:10.1016/S0140-6736(17)30638-4); no adaptation. The XML is not committed because of the non-commercial term; only its sha256 is kept. The PubMed record is not committed either. The Figure 3 image (gr3.jpg from the PMC figure page, same licence) is not committed; only its sha256 is kept, and its numbers were read from the image by eye.
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Background Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage
- Locator
- Recommendation 27, Remarks, bullet 4: timing evidence behind the 3-hour window
- How it applies
- WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de- 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.
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Background Department of Error (correction to the WOMAN trial report)
- Locator
- Erratum text: tranexamic acid concentration corrected in the procedures section
- How it applies
- The correction changes a drug concentration, not a result.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
4d208f181f5cdbc06acf1817fcc38b5c0f1aa32848784237eed45c1e13fbbf6d- Reuse basis
- PMC6891225 is open access under CC BY-NC-ND 4.0, as its own XML states. Short quotation with attribution; the XML is not committed.
Context Women with postpartum haemorrhage after vaginal or caesarean birth, treated within 3 hours of birth (WHO 2025 Recommendation 27)
- Recipient
- Maternal
- Population
- Women with postpartum haemorrhage after vaginal birth or caesarean section. WHO aligns the diagnosis with its objective criteria (Recommendations 21 and 22) and no longer relies on clinical estimation alone, so this population is not identical to the clinically diagnosed women in WOMAN. Treatment is started within 3 hours of birth, counted from the time of birth.
- Care setting
- Settings where emergency obstetric care is provided. Intravenous use only.
- Geography
- Global (WHO guidance intended to inform national and subnational policy).
- Life stage
- Postpartum, within 3 hours of birth
- Gestational age
- Not reported
- Postnatal age
- Not reported
- Follow-up
- Not applicable (recommendation context)
Eligibility: 1 inclusion criterion; 2 exclusion criteria
- Included
- Postpartum haemorrhage after vaginal birth or caesarean section
- Excluded
- A clear contraindication to antifibrinolytic therapy, for example a known thromboembolic event during pregnancy (WHO remarks)
- More than 3 hours after birth (WHO does not support use then)
WHO, FIGO and ICM recommend, in the 2025 consolidated guideline (Recommendation 27), giving tranexamic acid into a vein early, within 3 hours of birth, in addition to standard care, for women with postpartum haemorrhage after vaginal birth or caesarean section. The category is Recommended. WHO remarks give 1 g (100 mg/mL) at 1 mL per minute, with a second 1 g dose if bleeding continues after 30 minutes or restarts within 24 hours. The 3 hours are counted from the time of birth, intravenous use only, and the medicine should be avoided with a clear contraindication. This is a treatment recommendation. WHO 2025 does not recommend the medicine for prevention (separate claim).
Applies to Maternal- Women with postpartum haemorrhage after vaginal birth or caesarean section. WHO aligns the diagnosis with its objective criteria (Recommendations 21 and 22) and no longer relies on clinical estimation alone, so this population is not identical to the clinically diagnosed women in WOMAN. Treatment is started within 3 hours of birth, counted from the time of birth.
- Settings where emergency obstetric care is provided. Intravenous use only.
- Global (WHO guidance intended to inform national and subnational policy).
- Postpartum, within 3 hours of birth
- Gestational age Not reported
- Postnatal age Not reported
- Certainty method
- Not assessed
- Limitations
- WHO labels this recommendation Edited, meaning an existing recommendation with no new impactful evidence, edited for clarity. The 2017 WHO wording said clinically diagnosed and carried the label strong recommendation, moderate quality of evidence; the 2025 text aligns diagnosis with the objective criteria of Recommendations 21 and 22, so its population is not identical to WOMAN clinically diagnosed women. WHO 2025 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 guideline is co-published with FIGO and ICM; WHO is recorded as issuer because no organisation records exist yet for the other two. WHO web annexes with the evidence base were not read. Supersession was checked only by one IRIS keyword search on 2026-10-11, which listed no later WHO PPH guideline among the newest items it returned. This is not a thorough search.
- Last checked
- 2026-10-11
- Next evidence check due
- Not scheduled
Sources and citations (6)
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Supports Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage
- Locator
- Recommendation 27: recommendation text and category
- How it applies
- WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de- 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.
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Supports Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage
- Locator
- Recommendation 27, Remarks, bullet 1: dose and second dose
- How it applies
- WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de- 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.
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Supports Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage
- Locator
- Recommendation 27, Remarks, bullets 2 to 4: diagnosis alignment, 3-hour window from birth, no use after 3 hours
- How it applies
- WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de- 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.
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Supports Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage
- Locator
- Recommendation 27, Remarks, bullets 7 and 8: contraindication and intravenous use only
- How it applies
- WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de- 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.
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Background Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage
- Locator
- Summary list of recommendations, footnote to Recommendation 27: integrated from the 2017 recommendation
- How it applies
- WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de- 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.
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Background WHO recommendation on tranexamic acid for the treatment of postpartum haemorrhage
- Locator
- Table 1: the 2017 wording and its strength label
- How it applies
- WHO 2017 recommendation, CC BY-NC-SA 3.0 IGO; history only.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
b19ff1c62e7725cb8a0c488ff85135894d95c281583e4d5b5e911afa3ff99723- 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.
Guidance
Recommended: Tranexamic acid for treating postpartum haemorrhage
Applies to Maternal
- Women with postpartum haemorrhage after vaginal birth or caesarean section. WHO aligns the diagnosis with its objective criteria (Recommendations 21 and 22) and no longer relies on clinical estimation alone, so this population is not identical to the clinically diagnosed women in WOMAN. Treatment is started within 3 hours of birth, counted from the time of birth.
- Settings where emergency obstetric care is provided. Intravenous use only.
- Global (WHO guidance intended to inform national and subnational policy).
- Postpartum, within 3 hours of birth
- Gestational age Not reported
- Postnatal age Not reported
- Issued by
- World Health Organization
- 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.
- Strength
- Recommended
- Effective
- 2025-10-05
- Jurisdiction
- Global (WHO guidance intended to inform national and subnational policy). Co-published with FIGO and ICM.
- Basis
- WHO, FIGO and ICM recommend, in the 2025 consolidated guideline (Recommendation 27), giving tranexamic acid into a vein early, within 3 hours of birth, in addition to standard care, for women with postpartum haemorrhage after vaginal birth or caesarean section. The category is Recommended. WHO remarks give 1 g (100 mg/mL) at 1 mL per minute, with a second 1 g dose if bleeding continues after 30 minutes or restarts within 24 hours. The 3 hours are counted from the time of birth, intravenous use only, and the medicine should be avoided with a clear contraindication. This is a treatment recommendation. WHO 2025 does not recommend the medicine for prevention (separate claim).
Limitations. WHO labels this recommendation Edited, meaning an existing recommendation with no new impactful evidence, edited for clarity. The 2017 WHO wording said clinically diagnosed and carried the label strong recommendation, moderate quality of evidence; the 2025 text aligns diagnosis with the objective criteria of Recommendations 21 and 22, so its population is not identical to WOMAN clinically diagnosed women. WHO 2025 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 guideline is co-published with FIGO and ICM; WHO is recorded as issuer because no organisation records exist yet for the other two. WHO web annexes with the evidence base were not read. Supersession was checked only by one IRIS keyword search on 2026-10-11, which listed no later WHO PPH guideline among the newest items it returned. This is not a thorough search.
Clinical links
Each link reports what one cited claim says about one population. "Evaluated for" means studied, not shown to work. These links do not show that anything is effective or right for you.
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Claim, not a settled fact Evaluated in WOMAN for death due to bleeding: Postpartum haemorrhage
Applies to Maternal- Women aged 16 years and older with a clinical diagnosis of postpartum haemorrhage after a vaginal birth or caesarean section. WOMAN specified that the diagnosis could rest on clinically estimated blood loss of more than 500 mL after vaginal birth or 1000 mL after caesarean section, or any blood loss sufficient to compromise haemodynamic stability. This is the trial eligibility wording, not a WHO definition. The fundamental eligibility criterion was the clinician uncertainty about whether to use tranexamic acid in that woman. The overall result covers every treatment time.
- Hospitals (193 in the paper).
- Hospitals in 21 countries. The paper site list names Nigeria, Pakistan, Uganda, Kenya, Cameroon, Sudan, United Kingdom, Tanzania, Nepal, Zambia, Albania, Democratic Republic of Congo, Bangladesh, Ethiopia, Burkina Faso, Jamaica, Ghana, Papua New Guinea, Egypt, Colombia and Cote d'Ivoire.
- Postpartum, treated within hours of birth or later
- Gestational age Not reported
- Postnatal age Not reported
In the WOMAN trial, women with heavy bleeding after birth who were given tranexamic acid were less likely to die of bleeding than women given a placebo. 155 of 10 036 women (1.5%) died of bleeding with tranexamic acid, against 191 of 9985 (1.9%) with placebo. The risk ratio was 0.81 (95% confidence interval 0.65 to 1.00, p=0.045). The authors named death due to bleeding as the key secondary outcome. The upper end of the interval touches 1.00, and the primary outcome, death from any cause or hysterectomy, did not differ clearly between the groups (separate claim).Source problem. A cited source is corrected. Check the sources before relying on this claim.
Limitations. Death due to bleeding is a cause-specific secondary outcome. The primary composite showed no clear difference. The upper confidence bound is 1.00. The planned sample of 15 000 was raised to 20 000 during the trial to estimate this effect, after hysterectomy decisions were found to be often made at the time of randomisation. The authors state that they pre-specified this outcome and the time-to-treatment subgroups before un-blinding. Clinicians recorded the immediate cause of death, the main cause if there were several. The trial was double-blind. The paper also gives an adjusted risk ratio of 0.78 (95% CI 0.62 to 0.98). Adverse events, including thromboembolic events, did not differ significantly between groups in WOMAN. Pfizer is among the funders and made the trial drug. Analysed numbers are those printed for this analysis (10 036 and 9985); some randomised women were excluded from analysis and the paper prints no total. Source correction: the Lancet printed a correction to this paper (a Department of Error notice; the online article was corrected on 5 May 2017). It changes one number in the procedures section, the tranexamic acid concentration, from 10 mg/mL to 100 mg/mL. The correction notice lists this one change and no other, and the text read for this claim is the corrected text. The source state shows Corrected for that reason.
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Claim, not a settled fact Evaluated in WOMAN for death or hysterectomy, with no clear difference: Postpartum haemorrhage
Applies to Maternal- Women aged 16 years and older with a clinical diagnosis of postpartum haemorrhage after a vaginal birth or caesarean section. WOMAN specified that the diagnosis could rest on clinically estimated blood loss of more than 500 mL after vaginal birth or 1000 mL after caesarean section, or any blood loss sufficient to compromise haemodynamic stability. This is the trial eligibility wording, not a WHO definition. The fundamental eligibility criterion was the clinician uncertainty about whether to use tranexamic acid in that woman. The overall result covers every treatment time.
- Hospitals (193 in the paper).
- Hospitals in 21 countries. The paper site list names Nigeria, Pakistan, Uganda, Kenya, Cameroon, Sudan, United Kingdom, Tanzania, Nepal, Zambia, Albania, Democratic Republic of Congo, Bangladesh, Ethiopia, Burkina Faso, Jamaica, Ghana, Papua New Guinea, Egypt, Colombia and Cote d'Ivoire.
- Postpartum, treated within hours of birth or later
- Gestational age Not reported
- Postnatal age Not reported
The primary outcome of WOMAN was death from any cause or hysterectomy within 42 days, counted in the methods from randomisation. Tranexamic acid did not clearly reduce it. 534 women in the tranexamic acid group and 546 in the placebo group had the outcome, a risk ratio of 0.97 (95% CI 0.87 to 1.09, p=0.65). Hysterectomy alone was also not reduced (358 with tranexamic acid and 351 with placebo, risk ratio 1.02, 95% CI 0.88 to 1.07 as printed, p=0.84). The fewer deaths from bleeding seen in this trial did not show up in this combined outcome.Source problem. A cited source is corrected. Check the sources before relying on this claim.
Limitations. The composite joins death with hysterectomy. The authors expected hysterectomy decisions made at the time of randomisation to dilute any effect on hysterectomy. No composite outcome record exists in this atlas, so no finding rows are entered, and this composite is never placed on the all-cause death outcome. The printed placebo percentage differs between the abstract (5.5%) and the results text (5.6%) and is not used. The hysterectomy interval is printed identically in the abstract and the results text as 0.88 to 1.07 around a ratio of 1.02, which is not symmetric; it is recorded as printed and was not recomputed, and the table itself was not located. The denominators printed for the composite are 10 032 (tranexamic acid, Table 3) and 9985 (placebo). Source correction: the Lancet printed a correction to this paper (a Department of Error notice; the online article was corrected on 5 May 2017). It changes one number in the procedures section, the tranexamic acid concentration, from 10 mg/mL to 100 mg/mL. The correction notice lists this one change and no other, and the text read for this claim is the corrected text. The source state shows Corrected for that reason.
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Claim, not a settled fact WHO 2025 Recommendation 27: recommended, within 3 hours of birth: Postpartum haemorrhage
Applies to Maternal- Women with postpartum haemorrhage after vaginal birth or caesarean section. WHO aligns the diagnosis with its objective criteria (Recommendations 21 and 22) and no longer relies on clinical estimation alone, so this population is not identical to the clinically diagnosed women in WOMAN. Treatment is started within 3 hours of birth, counted from the time of birth.
- Settings where emergency obstetric care is provided. Intravenous use only.
- Global (WHO guidance intended to inform national and subnational policy).
- Postpartum, within 3 hours of birth
- Gestational age Not reported
- Postnatal age Not reported
WHO, FIGO and ICM recommend, in the 2025 consolidated guideline (Recommendation 27), giving tranexamic acid into a vein early, within 3 hours of birth, in addition to standard care, for women with postpartum haemorrhage after vaginal birth or caesarean section. The category is Recommended. WHO remarks give 1 g (100 mg/mL) at 1 mL per minute, with a second 1 g dose if bleeding continues after 30 minutes or restarts within 24 hours. The 3 hours are counted from the time of birth, intravenous use only, and the medicine should be avoided with a clear contraindication. This is a treatment recommendation. WHO 2025 does not recommend the medicine for prevention (separate claim).Limitations. WHO labels this recommendation Edited, meaning an existing recommendation with no new impactful evidence, edited for clarity. The 2017 WHO wording said clinically diagnosed and carried the label strong recommendation, moderate quality of evidence; the 2025 text aligns diagnosis with the objective criteria of Recommendations 21 and 22, so its population is not identical to WOMAN clinically diagnosed women. WHO 2025 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 guideline is co-published with FIGO and ICM; WHO is recorded as issuer because no organisation records exist yet for the other two. WHO web annexes with the evidence base were not read. Supersession was checked only by one IRIS keyword search on 2026-10-11, which listed no later WHO PPH guideline among the newest items it returned. This is not a thorough search.
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maternal:tranexamic-acid-pph-treatment- Content hash
94e874d13d3a4ce1d801f6c8a2c8f7562691e85201be058b0a152e2470b84be7