Primary post-partum haemorrhage, usually defined as a blood loss of more than 500 mL within 24 h of giving birth, is the leading cause of maternal death worldwide, responsible for about 100 000 deaths every year.1, 2, 3 Most of the deaths occur soon after giving birth and almost all (99%) occur in low-income and middle-income countries.4, 5

Tranexamic acid reduces bleeding by inhibiting the enzymatic breakdown of fibrinogen and fibrin by plasmin.6 Findings of a systematic review of clinical trials of tranexamic acid in surgery showed that the drug reduces blood loss by about one third.7, 8 Tranexamic acid reduces death due to bleeding in patients with trauma. The CRASH-2 trial,9 which recruited 20 211 adults with acute traumatic bleeding, showed that tranexamic acid reduced death due to bleeding, with no apparent increase in vascular occlusive events. Planned subgroup analysis of the effect of tranexamic acid by time from injury to the start of treatment showed……………………. continue reading