Efficacy of Prophylactic Policy-Driven Tranexamic Acid Administration during Cesarean Delivery in a Rural Healthcare...

Area of Science:

• Obstetrics and Gynecology
• Maternal Health
• Pharmacology

Background:

• Postpartum hemorrhage (PPH) is a critical global cause of maternal mortality.
• Established guidelines recommend early tranexamic acid (TXA) for PPH prevention.
• Cesarean delivery (CD) carries a risk of PPH, necessitating effective preventative strategies.

Purpose of the Study:

• To evaluate the efficacy of prophylactic tranexamic acid (TXA) administration during cesarean delivery (CD).
• To identify patient characteristics associated with TXA use under a new policy.
• To assess the impact of a TXA protocol on PPH rates in a rural, underserved tertiary care center.

Main Methods:

• An electronic quality assurance chart review analyzed over 2705 patients undergoing CD.
• Compared PPH rates before and after implementing a TXA administration protocol.
• Four groups were analyzed: pre-policy control, pre-policy PPH, post-policy control with TXA, and post-policy PPH with TXA.

Main Results:

• PPH rates decreased significantly from 9.7% to 1.5% with TXA use.
• Subset analysis showed reduced blood loss (896.4 mL vs 771.1 mL) and fewer transfusions (6.7% vs 1.1%) with TXA.
• TXA was more likely administered to patients with commercial insurance, specific demographics, and certain delivery complications.

Conclusions:

• Policy-driven, prophylactic tranexamic acid (TXA) administration during cesarean delivery effectively decreases postpartum hemorrhage (PPH) rates.
• The protocol demonstrated significant improvements in patient outcomes, including reduced blood loss and transfusion needs.
• Implementation in a rural, underserved setting highlights the broad applicability of TXA protocols for PPH prevention.