RCT

WOMAN-2

The effect of tranexamic acid on postpartum bleeding in women with moderate and severe anaemia

Lancet, 2024 · International randomized double-blind placebo-controlled trial (n=15,068)

Clinical question

Does prophylactic TXA shortly after vaginal birth prevent PPH in women with moderate or severe anemia?

Population: Women with hemoglobin <100 g/L after vaginal birth
Intervention: Tranexamic acid 1 g IV within 15 minutes after umbilical-cord clamping
Comparator: Placebo
Primary outcome: Clinically diagnosed primary postpartum hemorrhage
Result: PPH occurred in 7.0% with TXA vs 6.6% with placebo (RR 1.05, 95% CI 0.94–1.19).

What the trial found

Routine prophylactic TXA immediately after vaginal birth did not reduce clinically diagnosed PPH in women with moderate or severe anemia.

Current guideline position

TXA remains an early treatment for diagnosed PPH; routine prophylactic administration requires indication-specific evidence and should not be inferred from WOMAN treatment data.

Clinical interpretation

Do not extrapolate the WOMAN treatment benefit in established PPH into universal postpartum TXA prophylaxis.

Clinical Context & Relevant Topics (1)

Disease Reference

Obstetric Critical Care

Maternal physiology, preeclampsia/eclampsia, HELLP vs AFLP, postpartum hemorrhage (MTP/TXA), peripartum cardiomyopathy, and arrest.

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