Tranexamic Acid (TXA) in Obstetric Hemorrhage

This post was peer reviewed. Click to learn more.

Image Credit: Wikimedia

Authors: Patrick Wallace, DO, MS
Emergency Medicine Resident, PGY-2
University Nevada Las Vegas
AAEM/RSA Publications and Social Media Committee, and AAEM/RSA Education Committee

Laurie Bezjian Wallace, DO
Family Medicine Resident, PGY-2
Mike O’Callaghan Military Medical Center

Bottom Line Up Front: Tranexamic Acid (TXA) reduces postpartum hemorrhage with no major adverse events. There is some evidence to suggest routine use of TXA in all vaginal deliveries.

Introduction: Postpartum hemorrhage (PPH) is the leading cause of maternal deaths with over 100,000 deaths per year. It occurs in 3-15% of deliveries, making up about 25% of all maternal deaths worldwide.[1-5] The three most common causes of PPH can be remembered as the three T’s: tone, tissue, and trauma. Tone refers to uterine atony, tissue referrers to retained placental tissue, and trauma refers to cervical or perineal lacerations. Uterine atony is the most common cause of PPH and can be treated with bimanual massage and uterotonics such as oxytocin, methergine, or misoprostol.[2,5] American College of Obstetrics and Gynecology (ACOG) and World Health Organization (WHO) currently recommend routine prophylaxis with the administration of oxytocin during the third stage of labor.[2,5]

Tourniquet Application for Isolated Extremity Injuries

Image Credit: Staff Sgt. Terri Reece

Author: Kaylinn Dokken, OMS4
Western University of Health Sciences

This post was peer reviewed.
Click to learn more.

As we walk onto the scene wearing our bulletproof vests, we see a spray of blood up the white wall of the apartment, leading us to our patient. He is holding direct pressure on his arm where he had been shot. As soon as the pressure is removed, bright red, pulsatile blood sprays from the wound. Quickly, the paramedics I am riding with that day apply a tourniquet to the patient’s arm, and the bleeding is stopped.

Tourniquets have been used in the military through many wars, although their use was inconsistent, which led to poor outcomes for those with devastating limb injuries. At the start of the Iraq War, tourniquet use increased but was still inconsistent resulting in approximately 2% of soldiers dying from isolated limb exsanguination. There has been an increasing body of evidence showing favorable outcomes associated with tourniquet use. Due to the more consistent use of tourniquets through wartimes, exsanguination from isolated limb injuries is no longer considered a top cause of preventable death of US soldiers.[1]