Tranexamic acid as adjuvant treatment for postpartum hemorrhage: a systematic review protocol.

Objective: The objective of this review is to evaluate the effectiveness of intravenous administration of tranexamic acid (TXA) within three hours of birth in mothers with a diagnosis of postpartum hemorrhage (PPH).

Introduction: Postpartum hemorrhage, that is, blood loss exceeding 500 mL for vaginal births or 1000 mL for cesarean sections within 24 hours of delivery, is the leading cause of maternal deaths worldwide. The World Health Organization recommends intravenous TXA as an adjuvant therapy for the treatment of PPH, in addition to standard recommended treatments, within three hours of birth. This review will determine whether TXA administration to patients experiencing PPH leads to a reduction in blood loss, the requirement for transfusion of packed red blood cells and the need for emergency hysterectomies, in both developed and developing nations.

Inclusion criteria: This review will consider studies that include women under 40 with a diagnosis of postpartum hemorrhage. Studies that evaluate intravenous administration of TXA within three hours of birth as adjuvant treatment of postpartum hemorrhage will be considered. The comparator will be groups that have not received TXA as part of the treatment for postpartum hemorrhage, with or without placebo.

Methods: MEDLINE, Embase, CINAHL, CENTRAL, Scopus, Web of Science and ProQuest Nursing and Allied Health will be searched for eligible studies. The search for unpublished studies will include: ProQuest Dissertations and Theses (PQDT), ClinicalTrials.gov and New York Academy of Medicine Grey Literature Report. Retrieval of full-text studies, assessment of methodological quality and data extraction will be performed independently by two reviewers. Meta-analysis will be performed, if possible.