Evaluation of Prophylactic Tranexamic Acid in Lowering Blood Loss during Elective Cesarean Section: A Double-Blind Randomized Controlled Trial

International Journal of Obstetrics and Gynecology | Vol. 14, No. 7, July 2026 | pp. 97–108

DOI: 10.46882/2026/IJOG/000485

Original Research Article

Title: Evaluation of Prophylactic Tranexamic Acid in Lowering Blood Loss during Elective Cesarean Section: A Double-Blind Randomized Controlled Trial

Names of Authors: Ibrahim K. Sanusi¹, Chioma J. Nwachukwu¹

Authors’ Affiliations:
¹ Department of Obstetrics and Gynecology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

Abstract:
Cesarean section carries a baseline hemorrhage risk that significantly exceeds that of normal vaginal birth. This double-blind, placebo-controlled randomized trial investigated the efficacy and clinical safety of prophylactic intravenous tranexamic acid (TXA) in minimizing blood loss during and after elective cesarean deliveries. Three hundred and forty low-risk pregnant women at term scheduled for elective cesarean delivery under spinal anesthesia were randomized to receive either 1 g of intravenous TXA (n = 170) or a matching 0.9% saline placebo (n = 170) administered slowly 10 minutes prior to skin incision. Standard active management with oxytocin infusion was maintained in both arms. The primary outcome was the total calculated blood loss from the start of the incision until 2 hours postpartum, measured via gravimetric methods and hemoglobin drop. The mean total blood loss was significantly lower in the TXA group compared to the placebo group (385.4 ± 110.2 mL vs. 512.6 ± 145.8 mL, p < 0.001). The mean postpartum hemoglobin drop measured 24 hours after surgery was also significantly less in the TXA cohort (0.65 ± 0.22 g/dL vs. 1.15 ± 0.35 g/dL, p < 0.001). Only 1.2% of patients in the TXA arm experienced blood loss > 1,000 mL, compared to 5.9% in the placebo arm (p = 0.024). No thrombotic complications or serious drug-related maternal-fetal adverse events were noted up to 6 weeks postpartum (p > 0.05). Prophylactic administration of tranexamic acid significantly reduces blood loss and limits hemoglobin drops in women undergoing elective cesarean delivery without increasing hypercoagulable risks.

Keywords: Tranexamic Acid; Cesarean Section; Postpartum Hemorrhage; Blood Loss; Hemoglobin Drop; Prophylaxis.

Manuscript Timeline: Received: March 25, 2026; Revised: May 15, 2026; Accepted: June 14, 2026; Published: July 24, 2026.

Citation: Sanusi IK, Nwachukwu CJ. Evaluation of Prophylactic Tranexamic Acid in Lowering Blood Loss during Elective Cesarean Section: A Double-Blind Randomized Controlled Trial. International Journal of Obstetrics and Gynecology. 2026; 14(7): 97–108.

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