Tranexamic acid for the prevention and treatment of postpartum hemorrhage in resource-limited settings: a literature review

Abstract

Introduction: Postpartum hemorrhage is a major cause of maternal morbidity and mortality worldwide. Early recognition and appropriate treatment are crucial for managing postpartum hemorrhage. Objectives: This literature review aimed to evaluate the efficacy of tranexamic acid in the prevention and treatment of postpartum hemorrhage in resource-limited settings. Search methods: This literature review was conducted based on the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. A computerized systematic search of the MEDLINE (PubMed), Google Scholar, and Cochrane databases using a combination of the following Medical Subject Headings (MeSH) terms for PubMed: [(obstetric hemorrhage OR postpartum hemorrhage OR massive obstetric hemorrhage) AND (tranexamic acid OR antifibrinolytic drugs) AND (prophylaxis OR prevention) AND (management OR treatment) AND (resource-limited settings OR resource-limited area OR developing countries)] to find articles published in English since 2010. Selection criteria: Studies on the obstetric population who underwent vaginal or cesarean delivery, comparing the use of tranexamic acid versus placebo (or no treatment) for treatment (or prevention) of postpartum hemorrhage with the outcome of postpartum hemorrhage rate, blood transfusion requirements, uterotonics requirements, hysterectomy, or mortality were included. Result: In total, 5315 articles were identified. Following the elimination of duplicates, the methodological quality of 15 studies was evaluated independently, with eligibility determined based on the inclusion and exclusion criteria, as well as outcome variables. Finally, eight articles were included in the review. Conclusion: This review provides evidence that the administration of tranexamic acid has the potential to decrease the need for blood transfusion, incidence of postpartum hemorrhage, demand for supplementary uterotonics, and maternal morbidity and mortality with marginal adverse effects. Healthcare systems must develop and implement interventions that involve the use of tranexamic acid for the treatment of postpartum hemorrhage in resource-limited settings.