{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T03:07:34Z","timestamp":1790996854605,"version":"4.1.0"},"reference-count":26,"publisher":"BMJ","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ"],"accepted":{"date-parts":[[2026,4,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate whether prophylactic tranexamic acid reduces the incidence of postpartum haemorrhage in women with placenta praevia compared with placebo.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Randomised, double blind, placebo controlled, phase 3 study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>24 maternity units across China between July 2023 and March 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>1732 women with placenta praevia undergoing caesarean delivery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Participants were randomly (1:1) assigned to receive prophylactic oxytocin and either tranexamic acid (1 g in 10 mL) or placebo (10 mL normal saline) diluted in 40 mL normal saline intravenously over 10 minutes, initiated within five minutes of umbilical cord clamping.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was postpartum haemorrhage, defined as calculated estimated blood loss \u22651000 mL or as red cell transfusion within two days after delivery. Serious adverse events included thromboembolic events, seizures, acute kidney or liver injury, and maternal death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 1732 women with placenta praevia who were randomised, 38 were excluded because they withdrew consent or were determined to be ineligible after randomisation. Primary outcome data were available for 99.8% (1691\/1694) of the remaining women. Placenta accreta spectrum was diagnosed in 303 participants (17.9%). The primary outcome occurred in 29.7% (251\/845) of the tranexamic acid group and 35.1% (297\/846) of the placebo group (relative risk 0.85, 95.2% confidence interval (CI) 0.75 to 0.96; P=0.01). The rates of serious adverse events were similar between the tranexamic acid group and placebo group (0.5% (4 of 837)\n                      <jats:italic>v<\/jats:italic>\n                      0.5% (4 of 845); relative risk 1.01, 95% CI 0.25 to 4.00).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In women with placenta praevia who underwent caesarean delivery and received prophylactic oxytocin, treatment with tranexamic acid resulted in a statistically significant yet modest reduction in the incidence of postpartum haemorrhage, with no signal of increased serious adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      ClinicalTrials.gov\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"NCT05811676\" ext-link-type=\"clintrialgov\">NCT05811676<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmj-2026-089636","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:30:26Z","timestamp":1778718626000},"page":"e089636","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Prophylactic tranexamic acid for the prevention of postpartum haemorrhage in women with placenta praevia: multicentre, double blind, randomised, placebo controlled, phase 3 trial"],"prefix":"10.1136","volume":"393","clinical-trial-number":[{"clinical-trial-number":"nct05811676","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Lizi","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Centre for Obstetrics and Gynaecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shilei","family":"Bi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Centre for Obstetrics and Gynaecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lian","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Peking University Third Hospital, Beijing, China"},{"name":"State Key Laboratory of Female Fertility Promotion, Peking University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lili","family":"Du","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Centre for Obstetrics and Gynaecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang","family":"He","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Centre for Obstetrics and Gynaecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Qiao","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Northwest Women\u2019s and Children\u2019s Hospital, Xi\u2019an, Shanxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongjun","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, The Tenth Affiliated Hospital, Southern Medical University (Dongguan People\u2019s Hospital), Dongguan Key Laboratory of Major Diseases in Obstetrics and Gynaecology, Dongguan, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanjiang","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianlan","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xu","family":"Chen","sequence":"additional","affiliation":[{"name":"Tianjin Central Hospital of Obstetrics and Gynaecology, Tianjin, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaotian","family":"Li","sequence":"additional","affiliation":[{"name":"Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Women and Children\u2019s Medical Centre, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, 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