INTRODUCTION
Bleeding is a recognized complication of both obstetrical and gynecological procedures. In fact, obstetrical hemorrhage, a major cause of maternal morbidity1 is the leading cause of maternal death worldwide2. In gynecology, bleeding during benign gynecological surgery and due to benign gynecologic conditions is a major cause of morbidity3. Numerous studies show that tranexamic acid (TXA) decreases blood loss effectively in general surgical procedures; especially in trauma surgery4,5,6,7. The WOMAN trial demonstrates that TXA use for postpartum hemorrhage (PPH) reduces mortality. When used for postpartum hemorrhage, it causes no adverse events and most notably, no thromboembolic events8.The World Health Organization (WHO) recommends considering TXA in the standard postpartum hemorrhage protocol for both vaginal and cesarean sections9.
Currently, in the United States, cesarean sections account for 32% of all deliveries10. The blood loss for a cesarean delivery averages between 800ml to 1000 ml11. Approximately 5% of cesarean sections and 1% of vaginal deliveries require a blood transfusion12. In 2018, births in the United States totaled 3,791,71213. TXA has been shown to be an effective medication to decrease bleeding during cesarean section not only when used acutely but also prophylactically14,15,16.
TXA has been used since the 1970s as a non-hormonal medication to decrease menstrual bleeding in women with menorrhagia17. When compared to placebo it decreases heavy menses by 40%18. More recently, TXA use has been expanded to include benign surgical procedures such as hysterectomy and myomectomy. Hysterectomy is one of the most commonly performed surgical procedures in the United States, approximately 600,000 are performed each year. It is estimated that one in nine women will have a hysterectomy in their lifetime19. In recent years, randomized control trials and meta-analysis investigating TXA use in benign gynecology, for both hysterectomies and myomectomies, show an overall reduction in both total blood loss and need for reoperations due to postoperative hemorrhage20,21,22.
One commonality of these studies on TXA use is the lack of adverse events. Venous thromboembolism with the use of TXA for PPH, heavy menstrual bleeding, or benign gynecologic surgery is not shown to be a concern. Given these findings and the World Health Organization’s recommendations, our goal in conducting this study was to achieve a better understanding of the current use practices of TXA among obstetricians and gynecologists.