Bibliographic information
GuidelineConsolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage
Year of Publication2025
Issuing InstitutionWorld Health Organization
Recommendation
New
Antifibrinolytics for the prevention of postpartum haemorrhage. Tranexamic acid is not recommended for the prevention of postpartum haemorrhage at vaginal birth.
Not recommended
Notes and Remarks
- The GDG recognizes that this recommendation applies at the population level to all vaginal births and depends on the capacity to accurately assess blood loss and diagnose PPH. Future research may identify specific subpopulations that may benefit from prophylactic use of TXA before the onset of significant bleeding.
- TXA remains recommended for treatment of PPH and as part of the treatment bundle (Recommendation 29), where the balance of benefits and potential risks is well established and clearly favours its use.
- TXA is an antifibrinolytic – not a uterotonic – and should never be used as a substitute for first-line prophylactic uterotonics (oxytocin, carbetocin or misoprostol) when preventing PPH at vaginal birth. Its mechanism does not promote uterine contraction and, as shown by the evidence, it provides no added preventive benefit.