Tranexamic acid given during menstruation is a safe and highly effective treatment for excessive bleeding. Patients with dysfunctional uterine bleeding should be offered medical treatment with tranexamic acid before a decision is made about surgery.

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Objective To determine the behaviour of the coagulation variables antithrombin I11 (ATIII), protein C , thrombin/antithrombin 111 (TATIII); fibrinolytic activity, tissue plasminogen activator antigen (t-PA), plasminogen activator inhibitors (PAI) 1 and 2, and endothelial involvement by fibronectin assay in normal and pre-eclamptic pregnancies. Design Longitudinal and cross-sectional observational study.Setting Antenatal clinic and maternity hospital.Subjects Thirty-six primigravid normotensive Caucasian patients, four of whom subsequently developed pre-eclampsia, and 12 patients with established pre-eclampsia.Main outcome measures Plasma levels of PAI-1, PAI-2 and t-PA antigen were determined using an ELISA technique as were TATIII complex levels of fibronectin. ATIII and protein C plasma levels were assayed using chromogenic substrate techniques.Results PAI-1 and PAL2 antigen levels rose progressively throughout normal pregnancy. Among the established pre-eclamptic group compared with matched normal pregnancies, the PAI-2 antigen level was significantly lower (48.5 f 22.8 versus 183.5 k 37.4; P c 0*001), the PAI-I antigen level was significantly higher (122k34.4 versus 79.2f 19.7; P c 0.001), ATIII activity was significantly lower (87.8k27.1 versus 110.9+ 19.3; P c O*OOl) and TATIII complex levels were significantly higher (16.9k6.4 versus 102+ 5.9; P c 0.001). Among the four initially normotensive patients who subsequently developed pre-eclampsia, fibronectin levels were significantly elevated from as early as nine weeks of gestation.Conclusion Significantly elevated levels of PAI-1 and fibronectin occurring early in pregnancies that subsequently develop pre-eclampsia suggest that these variables may have predictive values. PAI-2 would seem to be a marker of placental function in pre-eclampsia while increased t-PA and TATIII complex levels reflect the severity of the condition.Despite recent advances in antenatal care, pre-eclampsia remains a major cause of maternal and perinatal mortality and morbidity (WHO 1987). Many centres have investigated markers for coagulation and fibrinolytic activation and for endothelial injury in order to characterise