POSTPARTUM HEMORRHAGE: CURRENT APPROACHES TO TREATMENT AND THE ROLE OF TRANEXAMIC ACID

Abstract

Postpartum hemorrhage remains one of the leading causes of maternal morbidity and mortality worldwide. Despite advances in obstetric care, adverse outcomes are largely attributable to delayed recognition of blood loss, delays in initiating treatment, and inadequate coordination of medical interventions. This article aims to summarize current approaches to the diagnosis and treatment of postpartum hemorrhage, analyze the evidence supporting the use of tranexamic acid, and define its role in current clinical guidelines. A narrative review of international guidelines, randomized controlled trials, and systematic reviews addressing the management of postpartum hemorrhage was conducted. The review examined recommendations issued by the World Health Organization (2023, 2025) and the International Federation of Gynecology and Obstetrics (2022), findings from the WOMAN, E-MOTIVE, WOMAN-2, and TRAAP trials, and a systematic review with an individual patient data meta-analysis of randomized trials published in 2024. Current principles of objective blood loss assessment, early recognition of hemodynamic instability, administration of uterotonics, fluid and transfusion support, and invasive hemostatic interventions are discussed. Particular attention is given to the antifibrinolytic mechanism of action of tranexamic acid, the optimal timing of administration, its efficacy, and safety. The WOMAN trial demonstrated a reduction in bleeding-related mortality with early administration of the drug, while the 2024 meta-analysis showed a reduced risk of life-threatening bleeding. However, the WOMAN-2 and TRAAP trials did not demonstrate the efficacy of routine prophylactic administration of tranexamic acid in the populations studied. It is concluded that early administration of tranexamic acid as part of comprehensive postpartum hemorrhage management is of considerable clinical importance, whereas its prophylactic use requires strict adherence to current recommendations.

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