Effectiveness of tranexamic acid in intervening postpartum vaginal lacerations

This prospective randomized controlled study aimed to investigate the effectiveness of tranexamic acid in controlling bleeding due to postpartum vaginal lacerations and to compare the intravenous (IV) and topical routes of administration. The rationale for exploring topical administration was to identify a more practical and less invasive alternative to IV administration.

Between January 2024 and November 2024, 161 women aged 20-35 years who had spontaneous vaginal deliveries without episiotomy at Mardin Education and Research Hospital, experienced superficial vaginall acerations, and had postpartum blood loss not exceeding 500 ml were included. All pregnancies were singleton, without fetal anomalies, and the length of labor was documented. Patients were randomly assigned to one of three groups: topical tranexamic acid (1g in 10ml salineapplied to the laceration for 10 minutes), IV tranexamic acid (1g infused over 10 minutes), or a control group (no tranexamic acid). Blood loss was assessed using the gravimetric method by measuring the weight difference of blood-soaked pads. Hemoglobin, hematocrit, platelet counts, and INR values were measured before birth and at the3rd postpartum hour.

Blood loss (pad count and total pad weight) was significantly lower in both tranexamic acid groups compared to the control group (p < 0.001). However, there was no significant difference in blood loss between the topical and IV tranexamic acid groups (p = 0.288 and p = 1.000, respectively). The decrease in hemoglobin was significantly lower in the IV tranexamic acid group compared to the control group (p = 0.008), but no significant difference was observed between the topical and IV groups (p = 0.113). Hospital stay was significantly shorter in the topical tranexamic acid group compared to the control group (p = 0.006), with no difference between the topical and IV groups (p = 0.406).

Topical tranexamic acid application resulted in similar reductions in bleeding compared with IV administration, and no statistically significant difference was detected between the two routes in this specific context of limited blood loss (< 500 ml). Given its practical advantages, topical application may be a viable alternative to IV administration. Further research is warranted to confirm these findings in cases of more significant postpartum hemorrhage.

Clinical trial NCT07094399. Registered 29 July 2025. Retrospectively registered, justification for the delay is provided in the methods section.