Abstract
Background
Africa is a developing continent with a high maternal mortality rate. It is beneficial to implement interventions that alleviate the problem. As a result, this systematic review and meta-analysis was carried out to summarize evidence that will assist concerned bodies in proposing strategies to reduce maternal mortality due to post-partum hemorrhage.
Methods
This systematic review and meta-analysis includes randomized control trials (RCT) studies searched from various databases (PubMed, Web of Sciences, SCOPUS, African Journal Online, Clinical trials, and African indexes Medics). Data synthesis and statistical analysis were conducted using a combination of review manager 5.3 and STATA Version 14 software. The effect measure utilized was the standardized mean difference for estimated mean blood loss and mean hemoglobin level.
Results
This systematic review and meta-analysis includes a total of 3308 women. The pooled standardized mean difference showed that tranexamic acid statistical significantly reduced the estimated amount of blood loss after vaginal delivery (standardized mean difference with 95% CI − 0.93 [− 1.45, − 0.41]) and during and after cesarean delivery (standardized mean difference with 95% CI − 1.93 [− 2.40, − 1.47]).
Conclusion
Tranexamic acid has been found to be a good choice for reducing blood loss during and after delivery in Africa regardless of the mode of delivery. Tranexamic acid had no effect on hemoglobin levels before and after delivery. To reduce maternal mortality due to post-partum hemorrhage, it is critical to implement and strengthen interventions aimed at increasing tranexamic acid uptake in Africa.
Similar content being viewed by others
Data availability
The data that support the review findings of this study are available upon submitting a reasonable request to the corresponding author.
Abbreviations
- C/D:
-
Cesarean delivery
- MeSHs:
-
Medical subject headings
- PPH:
-
Postpartum hemorrhage
- PRISMA:
-
Preferred reporting items for systematic reviews and meta-analysis
- SMD:
-
Standardized mean difference
- TXA:
-
Tranexamic acid
- WHO:
-
World Health Organization
References
Ahmadzia HK et al (2018) Tranexamic acid for prevention and treatment of postpartum hemorrhage: an update on management and clinical outcomes. Obstet Gynecol Surv 73(10):587–594
Bateman BT et al (2010) The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries. Anesth Analg 110(5):1368–1373
Mpemba F, Kampo S, Zhang X (2014) Towards 2015: post-partum hemorrhage in sub-Saharan Africa still on the rise. J Clin Nurs 23(5–6):774–783
Musarandega R, Nyakura M, Machekano R, Pattinson R, Munjanja SP (2021) Causes of maternal mortality in sub-Saharan Africa: a systematic review of studies published from 2015 to 2020. J Glob Health 11
Tort J et al (2015) Factors associated with postpartum hemorrhage maternal death in referral hospitals in senegal and Mali: a cross-sectional epidemiological survey. BMC Pregnancy Childbirth 15(1):1–9
Besaina R et al (2019) Maternal mortality related to postpartum hemorrhage: a case-control study at the Befelatanana maternity of Madagascar. Int J Reprod Contracept Obstet Gynecol 8(1):121–127
Alam A et al (2017) Protocol for a pilot, randomized, double-blinded, placebo-controlled trial of prophylactic use of tranexamic acid for preventing postpartum hemorrhage (TAPPH-1). BMJ Open 7(10):e018586
Assumma V, Datola G, Mondini G (2021) New Cohesion Policy 2021–2027: the role of indicators in the assessment of the SDGs targets performance. International conference on computational science and its applications. Springer, Cham
Sudhof LS, Shainker SA, Einerson BD (2019) Tranexamic acid in the routine treatment of postpartum hemorrhage in the United States: a cost-effectiveness analysis. Am J Obstet Gynecol. https://doi.org/10.1016/j.ajog.2019.06.030
McCormack PL (2012) Tranexamic acid. Drugs 72(5):585–617
FMOH, Ethiopia-health-sector-transformation-plan.pdf. 2015. https://www.globalfinancingfacility.org/sites/gff_new/files/Ethiopia-health-system-transformation-plan.pdf
Page MJ et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int J Surg 88:105906
Diop A et al (2020) A double-blind, randomized controlled trial to explore oral tranexamic acid as an adjunct for the treatment for postpartum hemorrhage. Reprod Health 17(1):1–7
Abd El-Gaber AE-N et al (2018) Effect of tranexamic acid in the prevention of postpartum hemorrhage in elective cesarean delivery: a randomized controlled study. Inter J Reprod, Contracept, Obstet Gynecol. 80(1):1
Abdel-Aleem H et al (2013) Effectiveness of tranexamic acid on blood loss in patients undergoing elective cesarean section: randomized clinical trial. J Maternal-Fetal Neonatal Med 26(17):1705–1709
Abbas AM, Shady NW, Sallam HF (2019) Bilateral uterine artery ligation plus intravenous tranexamic acid during cesarean delivery for placenta previa: a randomized double-blind controlled trial. J Gynecol Obstet Hum Reprod 48(2):115–119
Sterne JA et al (2019) RoB 2: a revised tool for assessing the risk of bias in randomized trials. BMJ 28:366
Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50(4):1088–1101
Egger M et al (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634
Patsopoulos NA, Evangelou E, Ioannidis JP (2008) Sensitivity of between-study heterogeneity in meta-analysis: proposed metrics and empirical evaluation. Int J Epidemiol 37(5):1148–1157
Shalaby MA et al (2022) Safety and efficacy of preoperative tranexamic acid in reducing intraoperative and postoperative blood loss in high-risk women undergoing cesarean delivery: a randomized controlled trial. BMC Pregnancy Childbirth. https://doi.org/10.1186/s12884-022-04530-4
Ahmed MR et al (2015) Efficacy of tranexamic acid in decreasing blood loss in elective cesarean delivery. j Matern-Fetal Neonatal Med 28(9):1014–1018
Alanwar A, Gamal MM (2020) Tranexamic acid and ethamsylate for reducing blood loss in patient undergoing lower segment cesarean section at high risk for post-partum hemorrhage: a pilot study. J Obstetrics Gynecol 10(09):1340–1350
Ali MM et al (2021) Prevention of postpartum hemorrhage after vaginal delivery using tranexamic acid. Egyptian J Hospital Med 85(1):2937–2940
Anouar J, Sofiène A, Abdallah D, Doulira L, Kaïs C, Kamel K (2018) Effects of tranexamic acid on post partum hemorrhage due to uterine atony after cesarean section delivery a randomized, placebo controlled trial. La Tunisie Chirurgicale 2018. http://www.tunisiechirurgicale.com/Article_227_effects_of_tranexamic_acid_on_post_partum_hemorrhage_due_to_uterine_atony_after_cesarean_section_delivery_a_randomized_placebo_controlled
Elhamid AA, Hamdy A, Saleem SA (2017) A Single large dose of tranexamic acid before vaginal delivery: is it beneficial? Egyptian J Hospital Med 69(6):2601–2606
Fahmy NG et al (2021) Assessment of the role of tranexamic acid in the prevention of postpartum hemorrhage. Ain-Shams J Anesthesiol. https://doi.org/10.1186/s42077-021-00154-6
Maged AM et al (2015) A randomized placebo-controlled trial of preoperative tranexamic acid among women undergoing elective cesarean delivery. Int J Gynecol Obstet 131(3):265–268
Shady NW et al (2019) The effect of prophylactic oral tranexamic acid plus buccal misoprostol on blood loss after vaginal delivery: a randomized controlled trial. J Matern Fetal Neonatal Med 32(11):1806–1812
Igboke FN et al (2022) Tranexamic acid for reducing blood loss following vaginal delivery: a double-blind randomized controlled trial. BMC Pregnancy Childbirth. https://doi.org/10.1186/s12884-022-04462-z
Km M (2021) The efficacy of prophylactic tranexamic acid in reducing perioperative blood loss during caesarean section a randomized double-blind control trial. J Gynecol Women’s Health. https://doi.org/10.19080/JGWH.2021.21.556065
Oseni RO et al (2021) Effectiveness of preoperative tranexamic acid in reducing blood loss during cesarean section at Aminu Kano teaching hospital, Kano: a randomized controlled trial. Pan Afr Med J 39:34
Ford JB et al (2015) Trends and outcomes of postpartum hemorrhage, 2003–2011. BMC Preg Childbirth 15:334
Abrams ET, Rutherford JN (2011) Framing postpartum hemorrhage as a consequence of human placental biology: an evolutionary and comparative perspective. Am Anthropol 113(3):417–430
Hunt BJ (2015) The current place of tranexamic acid in the management of bleeding. Anaesthesia 70(50):e18
Novikova N, Hofmeyr GJ, Cluver C (2015) Tranexamic acid for preventing postpartum hemorrhage. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD007872.pub3
Sentilhes L et al (2020) TRAAP2–TRAnexamic acid for preventing postpartum hemorrhage after cesarean delivery: a multicenter randomized, double-blind, placebo-controlled trial–a study protocol. BMC Preg Childbirth 20(1):63
Al Wattar BH et al (2017) Management of obstetric postpartum hemorrhage: a national service evaluation of current practice in the UK. Risk Manag Health Policy 10:1–6
Fawcus S, Moodley J (2013) Postpartum hemorrhage associated with cesarean section and cesarean hysterectomy. Best Pract Res Clin Obstet Gynaecol 27(2):233–249
Updated W.H.O. (2017) Recommendation on tranexamic acid for the treatment of postpartum haemorrhage. Highlights and Key Messages from the World Health Organization’s. https://apps.who.int/iris/bitstream/handle/10665/259379/WHO-RHR-17.21-eng.pdf
Acknowledgements
We would like to thank the College of Health and Medical Sciences, Haramaya University for the support to perform these meta-analyses.
Funding
The authors have not disclosed any funding.
Author information
Authors and Affiliations
Contributions
AE, TG, AD, TT, and BB conceived and designed the review. AE*, TG, HB, MA, DT, and GT carried out the draft of the manuscript, and AE* is the PI of the review. AE*, TG, AD, and KS developed the search strings. AE, TG, KS, DT, MD, BE, SH, TB, ML, EY, GA and BB screened and selected studies. AE, HB, MA, GT, and AD extracted the data and evaluated the quality of the studies. AE, TT, AD, DT, MA, YD, and AA carried out analysis and interpretation. AE, TG, HB, DT, BB, AD, GT, MA, AM, FA, AA, AG. AA and TT rigorously reviewed the manuscript. All authors read and approved the final version of the manuscript.
Corresponding author
Ethics declarations
Conflict of interests
The authors declared that have no competing interests.
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Eyeberu, A., Getachew, T., Amare, G. et al. Use of tranexamic acid in decreasing blood loss during and after delivery among women in Africa: a systematic review and meta-analysis. Arch Gynecol Obstet 308, 709–725 (2023). https://doi.org/10.1007/s00404-022-06845-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-022-06845-1