{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T13:08:26Z","timestamp":1784725706448,"version":"3.55.0"},"reference-count":40,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,3,12]],"date-time":"2023-03-12T00:00:00Z","timestamp":1678579200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the effectiveness of tranexamic acid (TXA) in reducing blood loss during elective caesarean sections in women with and without risk factors for postpartum haemorrhage (PPH).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A double\u2010blind, randomised placebo\u2010controlled trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>An academic tertiary referral centre in Singapore.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Multiethnic women aged 21\u2009years or older undergoing elective caesarean section.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Randomisation to intravenous TXA or normal saline (placebo) 10 minutes before skin incision.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Calculated estimated blood loss (cEBL), derived from blood volume and haematocrit levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Between June 2020 and October 2021, 200 women were randomised to the placebo or TXA groups. Women who received prophylactic TXA had a significantly lower mean cEBL compared with those receiving placebo (adjusted mean difference \u2212126.4\u00a0mL, 95% CI \u2212243.7 to \u22129.1, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.035). The effect was greatest in those at high risk for PPH, with a reduction in cEBL (mean difference \u2212279.6\u00a0mL, 95% CI \u2212454.8 to \u2212104.3, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.002) and a lower risk of cEBL\u2009\u2265500\u2009mL (risk ratio [RR] 0.54, 95% CI 0.36\u20130.83, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.007) and cEBL\u2009\u22651000\u2009mL (RR 0.44, 95% CI 0.20\u20130.98, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.016). Subgroup analysis showed benefit for women with preoperative haemoglobin &lt;10.5\u00a0g\/dL (mean difference \u2212281.9\u00a0mL, 95% CI \u2212515.0 to \u221248.8, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.019). There was no significant difference in need for additional medical or surgical interventions. There were no maternal or neonatal adverse outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Prophylactic TXA should be considered in women with risk factors for PPH, and those most likely to benefit are those with preoperative haemoglobin &lt;10.5\u00a0g\/dL.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17445","type":"journal-article","created":{"date-parts":[[2023,2,28]],"date-time":"2023-02-28T08:09:18Z","timestamp":1677571758000},"page":"1007-1015","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Tranexamic acid, as an adjunct to oxytocin prophylaxis, in the prevention of postpartum haemorrhage in women undergoing elective caesarean section: A single\u2010centre double\u2010blind randomised controlled trial"],"prefix":"10.1111","volume":"130","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8369-9336","authenticated-orcid":false,"given":"Shi Hui","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology KK Women's and Children's Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle E\u2010Jyn","family":"Kwek","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology KK Women's and Children's Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shephali","family":"Tagore","sequence":"additional","affiliation":[{"name":"Department of Maternal Fetal Medicine KK Women's and Children's Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"Wright","sequence":"additional","affiliation":[{"name":"Department of Maternal Fetal Medicine KK Women's and Children's Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chee Wai","family":"Ku","sequence":"additional","affiliation":[{"name":"Department of Reproductive Medicine KK Women's and Children's Hospital  Singapore Singapore"},{"name":"Duke\u2010NUS Medical School|  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aimee Chuin Ai","family":"Teong","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology KK Women's and Children's Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda Wei Mun","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology KK Women's and Children's Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santi Wei Che","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology KK Women's and Children's Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Desiree Yu Ting","family":"Yen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology KK Women's and Children's Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassandra Yang Xuan","family":"Ang","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology KK Women's and Children's Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rehena","family":"Sultana","sequence":"additional","affiliation":[{"name":"Centre of Quantitative Medicine Duke\u2010NUS Medical School  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celeste Hong Fei","family":"Lim","sequence":"additional","affiliation":[{"name":"National University Singapore, Yong Loo Lin School of Medicine  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepak","family":"Mathur","sequence":"additional","affiliation":[{"name":"Department of Women's Anaesthesia KK Women's and Children's Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manisha","family":"Mathur","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology KK Women's and Children's Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,3,12]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(14)70227-X"},{"key":"e_1_2_12_3_1","volume-title":"WHO guidelines approved by the guidelines review Committee","author":"WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage","year":"2012"},{"key":"e_1_2_12_4_1","first-page":"e106","article-title":"Prevention and management of postpartum haemorrhage","volume":"124","author":"Mavrides E","year":"2016","journal-title":"BJOG"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-018-0527-2"},{"key":"e_1_2_12_6_1","volume-title":"Saving lives, improving Mothers\u2019 Care \u2010 lessons learned to inform maternity care from the UK and Ireland confidential enquiries into maternal deaths and morbidity 2017\u201319","author":"Knight M","year":"2021"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/GRF.0b013e3181cc406d"},{"key":"e_1_2_12_8_1","first-page":"442","article-title":"Postpartum hemorrhage: prevention and treatment","volume":"95","author":"Evensen AAJ","year":"2017","journal-title":"Am Fam Physician"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30638-4"},{"key":"e_1_2_12_10_1","unstructured":"WHO Recommendation on Tranexamic Acid for the Treatment of Postpartum Haemorrhage.WHO guidelines approved by the guidelines review Committee.Geneva2017."},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/1933719115623646"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2016.01.184"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e3054"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60835-5"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)32455-8"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tmrv.2015.07.002"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aeu448"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2028788"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2008.04.049"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0035-1552940"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0030-1268238"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2021.09.025"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogoh.2020.101973"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2013.794210"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.4103\/nnjcr.nnjcr_25_20"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10995-022-03450-1"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2015.09.032"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.4236\/ojog.2019.96089"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.4103\/1658-354X.121077"},{"issue":"39","key":"e_1_2_12_30_1","first-page":"34","article-title":"Effectiveness of preoperative tranexamic acid in reducing blood loss during caesarean section at Aminu Kano teaching hospital, Kano: a randomized controlled trial","volume":"12","author":"Oseni RO","year":"2021","journal-title":"Pan Afr Med J"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2019.1571576"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-022-04462-z"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1800942"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2020.12.997"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000559201.11815.25"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-015-0653-6"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003564"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0041-1742267"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10877-020-00579-8"},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12630-020-01857-4"},{"key":"e_1_2_12_41_1","unstructured":"Bordeaux UHo.TRAnexamic acid for preventing blood loss following a cesarean delivery in women with Placenta pREVIA (TRAAPrevia)."}],"container-title":["BJOG: An International Journal of Obstetrics &amp; Gynaecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1471-0528.17445","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/1471-0528.17445","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1471-0528.17445","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,16]],"date-time":"2023-08-16T19:07:27Z","timestamp":1692212847000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/1471-0528.17445"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,12]]},"references-count":40,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2023,8]]}},"alternative-id":["10.1111\/1471-0528.17445"],"URL":"https:\/\/doi.org\/10.1111\/1471-0528.17445","archive":["Portico"],"relation":{},"ISSN":["1470-0328","1471-0528"],"issn-type":[{"value":"1470-0328","type":"print"},{"value":"1471-0528","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,12]]},"assertion":[{"value":"2022-12-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-02-23","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-03-12","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}