What medication can be given to pregnant women to stop bleeding after a miscarriage?

Management of Bleeding After Miscarriage

Tranexamic acid (TXA) is strongly recommended as the first-line medication to stop bleeding in women after miscarriage, administered at a dose of 1g IV over 10 minutes within 3 hours of the event. 1, 2

First-Line Management

• Tranexamic acid should be administered intravenously at a fixed dose of 1g (100 mg/mL) given at 1 mL/min (over 10 minutes) 1, 2
• A second dose of 1g IV should be given if bleeding continues after 30 minutes or if bleeding restarts within 24 hours of the first dose 1, 2
• TXA must be administered within 3 hours of the miscarriage, as delay reduces benefit by approximately 10% for every 15 minutes 1
• TXA should not be given beyond 3 hours after the miscarriage as it may be potentially harmful 1
• TXA works by inhibiting fibrin degradation and has been shown to decrease bleeding complications and mortality 1

Comprehensive Management Approach

• In addition to TXA, standard care should include:
  • Fluid replacement with physiologic electrolyte solutions for volume resuscitation 2
  • Monitoring of vital signs to assess hemodynamic stability 2
  • Assessment of blood loss (clinically significant blood loss is defined as >500 mL after vaginal delivery or >1000 mL after cesarean section) 1, 2
  • Laboratory monitoring of hemoglobin, coagulation parameters, and fibrinogen levels (levels <200 mg/dL are associated with severe hemorrhage) 1

Second-Line Interventions

• If bleeding persists despite TXA administration, consider:
  • Non-surgical interventions such as bimanual compression 2
  • Surgical interventions if necessary, with suction aspiration being the most effective surgical method for retained products of conception 3
  • Blood product replacement may be necessary in cases of severe hemorrhage, with recommended ratios of 1:1:1 to 1:2:4 of packed red blood cells:fresh frozen plasma:platelets 1

Special Considerations

• TXA should be avoided in women with a clear contraindication to antifibrinolytic therapy (e.g., known thromboembolic event during pregnancy) 1
• Hypofibrinogenemia is the biomarker most predictive of severe hemorrhage; levels less than 200 mg/dL are associated with severe bleeding 1
• For women with incomplete miscarriage, medical management with misoprostol is an alternative option if TXA alone is insufficient to control bleeding 4

Common Pitfalls and Caveats

• Delaying TXA administration beyond 3 hours significantly reduces its effectiveness and may be harmful 1
• Underestimating blood loss can lead to delayed intervention; clinical assessment should be ongoing 2
• Failure to monitor coagulation parameters may miss developing coagulopathy 1
• The psychological impact of miscarriage is often underappreciated; appropriate supportive care should be provided alongside medical management 5, 6

Healthcare Facility Requirements

• Health facilities providing emergency obstetric care need appropriate supplies and trained staff to administer TXA safely by intravenous infusion 1, 2
• Sequential use of interventions should start with less invasive approaches, moving toward more invasive interventions as required 2

TXA has been shown to significantly reduce maternal death due to hemorrhage when administered promptly, making it an essential medication in the management of bleeding after miscarriage 1.