Guidelines for the management of urgent obstetric situations in emergency medicine, 2022

Tranexamic acid versus oxytocin for primary postpartum Haemorrhage in the out‐of‐hospital setting: A systematic review with implications for rural practice

“…From the evidence analysed in this review, oxytocin did not prove to be efficacious in reducing PPH blood loss, improving maternal and neonatal morbidity and mortality, or reducing the need for further interventions in both developed or developing countries, when compared to standard care or not implementing any intervention. [19][20][21][22][23] These findings contrast Salati et al (2019) 27 and Gonzalez et al (2021) 28 who found that prophylactic oxytocin within the third stage of labour may reduce the PPH blood loss and the need for further interventions and recommended the implementation of oxytocin for active management of the third stage of labour. While TXA demonstrated some effectiveness in preventing PPH, in comparison to no or standard interventions, it is critical to note that this data did not originate from the out-of-hospital setting; instead, Wren (2017) 20 discusses the applicability of TXA for paramedic use.…”

“…(2022) 23 strongly suggested administration of 1 g TXA within 1–3 h of onset of PPH to reduce maternal morbidity and mortality. Findings from a randomised study of 144 patients presenting with PPH post‐vaginal delivery with a significant reduction of blood loss (173 mL vs. 221 mL; p < 0.05) and a reduced number of transfused red blood cell concentrates ( p < 0.05) following TXA administration, in comparison to the non‐administration group, and results from the WOMAN trial 10 were used to support this recommendation 23 . Greenaway (2019) 18 supported these findings, adding maternal mortality was reduced by 31% in women administered TXA within 3 h of delivery (RR 0.69, 95% CI, p = 0.008).…”

“…Following the full-text screening, the six remaining articles were critically appraised. The studies by Greenaway (2019) 18 23 received a score of 8 of 10. A detailed explanation of each score can be found in Appendix S2.…”

“…The six studies included in this review consist of three systematic reviews, [19][20][21] 1 scoping literature review, 18 1 case-control study 22 and 1 expert consensus. 23 The studies by Wren (2017) 20 and Gallos et al (2018) 23 included both an emergency, in-hospital component and an out-of-hospital component, increasing the inclusive breadth of the evidence, as supported by JBI. A summary of the characteristics of these studies can be observed in Table S1.…”

“…21 Of 1000 women, receiving oxytocin post vaginal birth 76 were likely to experience hypertension (RR 0.84, 95% CI), 167 in 1000 would experience headache (RR 1.45, 95% CI), 24 in 1000 would experience fever (RR 1.06, 95% CI), 89 in 1000 would experience shivering (RR 0.70, 95% CI) and 11 in 1000 would experience diarrhoea (RR 1.25, 95% CI). 21 Bagou et al ( 2022) 23 strongly suggested administration of 1 g TXA within 1-3 h of onset of PPH to reduce maternal morbidity and mortality. Findings from a randomised study of 144 patients presenting with PPH postvaginal delivery with a significant reduction of blood loss (173 mL vs. 221 mL; p < 0.05) and a reduced number of transfused red blood cell concentrates (p < 0.05) following TXA administration, in comparison to the nonadministration group, and results from the WOMAN trial 10 were used to support this recommendation.…”