Topical tranexamic acid on episiotomy site for reducing postpartum hemorrhage: a double-blinded controlled trial

Episiotomy is a common obstetric procedure that can facilitate vaginal delivery. Despite its widespread use, it can cause complications such as an increase in postpartum hemorrhage, wound infection, and dehiscence. While tranexamic acid (TXA) has been shown to reduce surgical site bleeding and postpartum hemorrhage, the effect of topical TXA application on decreasing episiotomy bleeding remains unexplored. This study aims to evaluate the efficacy of topical TXA in reducing postpartum bleeding.

This double-blinded, controlled trial was conducted among 100 nulliparous pregnant women undergoing vaginal delivery. Participants were randomly divided into an intervention group, which received 1 g of TXA in 20 cc of normal saline topically on the episiotomy site, or a control group, which received 20 cc of normal saline as a placebo. Outcomes were measured based on changes in heart rate, systolic blood pressure, diastolic blood pressure, hemoglobin and hematocrit levels, postpartum hemorrhage, and wound healing complications, with the aim of comparing the amount of postpartum bleeding.

There were no statistically significant differences between topical TXA and placebo recipients regarding maternal and pregnancy variables, including age, body mass index, gestational age, newborn weight, use of vacuum assistance, augmentation of labor, medical conditions, postpartum bleeding, changes in heart rate, blood pressure, hemoglobin and hematocrit levels, episiotomy site infection, and wound dehiscence.

The topical application of TXA on the episiotomy site did not significantly reduce postpartum bleeding. Further studies with larger sample sizes and higher doses may provide more conclusive results.