From the Guidelines
Tranexamic acid is the drug of choice for postpartum bleeding, and it should be administered intravenously at a dose of 1 g (100 mg/mL) over 10 minutes, with a second dose of 1 g intravenously if bleeding continues after 30 minutes, or if bleeding restarts within 24 hours of completing the first dose. This recommendation is based on the latest evidence from the WOMAN trial, a randomised, double-blind, placebo-controlled trial that demonstrated the effectiveness of tranexamic acid in reducing maternal death due to bleeding in women with clinically diagnosed post-partum haemorrhage 1. The trial showed that early use of intravenous tranexamic acid, within 3 hours of birth, optimizes benefits and reduces maternal mortality.
Some key points to consider when administering tranexamic acid for postpartum bleeding include:
- The drug should be given in all cases of post-partum haemorrhage, regardless of whether the bleeding is thought to be due to genital tract trauma or for other reasons, including uterine atony 1.
- The dosage regimen used in the WOMAN trial, which is a fixed dose of 1 g (100 mg/mL) intravenously at 1 mL/min, is recommended 1.
- A second dose of 1 g intravenously may be given if bleeding continues after 30 minutes, or if bleeding restarts within 24 hours of completing the first dose 1.
- Tranexamic acid should be administered in addition to standard care for women with clinically diagnosed post-partum haemorrhage following vaginal birth or caesarean section 1.
It is essential to note that while oxytocin is often used as a first-line uterotonic agent, the latest evidence suggests that tranexamic acid should be administered promptly in cases of postpartum haemorrhage, regardless of the underlying cause of bleeding 1.
From the FDA Drug Label
Carboprost tromethamine injection is indicated for the treatment of postpartum hemorrhage due to uterine atony which has not responded to conventional methods of management. Prior treatment should include the use of intravenously administered oxytocin, manipulative techniques such as uterine massage and, unless contraindicated, intramuscular ergot preparations Oxytocin Injection, USP (synthetic) is indicated to produce uterine contractions during the third stage of labor and to control postpartum bleeding or hemorrhage.
The drug of choice for postpartum bleeding is oxytocin (IV) as the first line of treatment, and carboprost tromethamine (IM) can be used if the bleeding does not respond to conventional methods of management, including oxytocin 2, 2, 3.
- Oxytocin (IV) is used to produce uterine contractions during the third stage of labor and to control postpartum bleeding or hemorrhage.
- Carboprost tromethamine (IM) is used for the treatment of postpartum hemorrhage due to uterine atony which has not responded to conventional methods of management.
From the Research
Drug of Choice for Postpartum Bleeding
- Oxytocin is the most commonly used uterotonic agent to prevent postpartum hemorrhage, with no established standard dose 4.
- The effectiveness of oxytocin in preventing postpartum hemorrhage is dose-dependent, with higher infusion doses (up to 80 IU/500 mL) and bolus doses appearing to be more effective than lower doses or protracted administration 4, 5.
- Intravenous oxytocin may be superior to intramuscular oxytocin for the management of postpartum hemorrhage, with lower incidence rates of postpartum hemorrhage and blood transfusion 6.
Alternative Uterotonic Agents
- Methylergonovine and carboprost are highly effective second-line agents for the treatment of uterine atony, but have severe potential side effects 7.
- Methylergonovine may be associated with a reduced risk of hemorrhage-related morbidity compared to carboprost 8.
- Misoprostol is a useful therapeutic in resource-limited practice environments, but its effectiveness as an adjunct to other uterotonic agents has been called into question 7.