California State University, Fullerton, Fullerton, California.
Eisner Pediatric and Family Medical Center, Los Angeles, California.
J Midwifery Womens Health. 2020 May;65(3):410-416. doi: 10.1111/jmwh.13101. Epub 2020 May 19.
Tranexamic acid (TXA) is an antifibrinolytic pharmacologic agent with demonstrated effectiveness for reducing the incidence of death from blood loss following trauma and major surgery. In intrapartum care, TXA is being used in in conjunction with uterotonic agents to treat postpartum hemorrhage (PPH). Based on the findings of the WOMAN trial that found TXA reduced maternal death due to PPH, the World Health Organization recommends that TXA be part of the standard comprehensive PPH treatment package, and US professional organizations recognize its use as adjunctive treatment for PPH. Evidence suggests that TXA used prophylactically in the setting of cesarean birth may decrease blood loss and the incidence of PPH. There is limited evidence for prophylactic use of TXA in women of all risk categories following vaginal birth but prophylactic use in women who have an a priori risk for PPH is being investigated. This article presents a case in which a midwife identifies a woman in active labor who has significant risk factors for PPH. In consultation with the collaborating obstetrician, TXA is given early during the third stage of labor in addition to the recommended components of active management for the purpose of preventing PPH.
氨甲环酸（TXA）是一种抗纤维蛋白溶解的药物，已被证明可有效降低创伤和大手术后因失血导致的死亡率。在分娩期间，TXA 与子宫收缩剂联合用于治疗产后出血（PPH）。基于 WOMAN 试验的结果，TXA 可降低因 PPH 导致的产妇死亡，世界卫生组织建议 TXA 应成为 PPH 标准综合治疗方案的一部分，美国专业组织也承认其可作为 PPH 的辅助治疗。有证据表明，在剖宫产分娩时预防性使用 TXA 可减少出血量和 PPH 的发生率。对于阴道分娩的所有风险类别的女性预防性使用 TXA 的证据有限，但正在研究对有 PPH 预先风险的女性预防性使用 TXA。本文介绍了一位助产士在活跃分娩时识别出一位有发生 PPH 高风险因素的女性的案例。与合作的产科医生协商后，在第三产程早期除了给予推荐的积极管理的成分之外，还给予了 TXA，目的是预防 PPH。
