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Poster Session 3

Category: Clinical Obstetrics

Poster Session 3

(806) Tranexamic acid to prevent blood loss in women with low-risk of postpartum hemorrhage

Thursday, February 12, 2026

10:30 AM - 12:00 PM

Submitting Author and Presenting Author(s)

Hugo Madar, MD, PhD (he/him/his)

Doctor of Medicine in Obstetrics and Gynecology – Maternal Fetal Medicine
Bordeaux University Hospital
Bordeaux Universitary Hospital, Aquitaine, France

Coauthor(s)

CD

Catherine Deneux-Tharaux, MD, PhD

Université Paris Cité Institut Santé Des Femmes, Centre for Research in Epidemiology and Statistics (CRESS) U1153, Obstetrical Perinatal and Pediatric Epidemiology Research Team (Epopé), INSERM, INRAE, Paris, France.
Paris, Ile-de-France, France
Hanane Bouchghoul, MD, PhD (she/her/hers)

Associate Professor in Obstetrics and Gynecology – Maternal Fetal Medicine
Bordeaux University Hospital
Bordeaux Universitary Hospital, Aquitaine, France
AS

Aurelien Seco, MSc

Université Paris Cité Institut Santé Des Femmes, Centre for Research in Epidemiology and Statistics (CRESS) U1153, Obstetrical Perinatal and Pediatric Epidemiology Research Team (Epopé), INSERM, INRAE, Paris, France.
Paris, Ile-de-France, France
AF

Alizée Froeliger, MD

Attending Physician in Obstetrics
Bordeaux University Hospital
Bordeaux Universitary Hospital, Aquitaine, France
Loïc Sentilhes, FRCOG, MD, PhD (he/him/his)

Professor in Obstetrics and Gynecology – Maternal Fetal Medicine
Bordeaux University Hospital
Bordeaux Universitary Hospital, Aquitaine, France

Objective:
Prophylactic tranexamic acid (TXA) has been shown to reduce postpartum hemorrhage (PPH) in certain settings. However, its effectiveness may vary according to the baseline risk of PPH and remains underexplored in women with no identifiable risk factor for PPH. A recent meta-analysis (Yunas et al., Lancet 2025) identified updated risk factors for PPH which could modify the effectiveness of TXA. Therefore, we reanalyzed data from the TRAAP trial to compare the effect of TXA versus placebo to prevent PPH in women with low risk of PPH according to these updated PPH risk factors.

Study Design:
We included women from the modified intention-to-treat population of the multicenter, double-blind, randomized controlled TRAAP trial who underwent vaginal delivery of a singleton fetus and received TXA or placebo in addition to prophylactic oxytocin. We excluded women with one or more risk factors for PPH, as identified in the published meta-analysis: Black or Asian ethnicity, history of PPH, body mass index ≥25 kg/m², grand multiparous, gestational diabetes, thrombocytopenia, anemia, induction of labor, instrumental delivery, neonatal birthweight ≥ 4000g, among others. The primary outcome was PPH, defined as blood loss ≥500 mL measured with a calibrated collector bag.

Results:
Among the 3891 women randomized in the TRAAP trial, 1308 (33.6%) met the criteria for low-risk of PPH and were included in this analysis (660 received TXA and 648 received placebo). Baseline characteristics were similar (Table 1). PPH occurred in 42 of 656 women (6.4%) in the TXA group and 40 of 640 (6.3%) in the placebo group (risk ratio, 1.02; 95% CI, 0.67–1.56) (Table 2). No significant differences were observed in secondary outcomes, including blood loss ≥1000 mL, clinically assessed significant hemorrhage, use of additional uterotonics, total estimated blood loss, postpartum transfusion, or hemoglobin/hematocrit changes (all P > .05) (Table 2).

Conclusion:
Among women with low-risk of PPH who received prophylactic oxytocin after vaginal delivery, prophylactic TXA did not reduce the incidence of PPH.