Abstract
Background and Purpose:
Management of minor vaginal bleeding due to placenta previa remains largely supportive, as targeted pharmacological options are limited. This study evaluated the efficacy of intravenous tranexamic acid (TXA) in reducing recurrent vaginal bleeding and improving perinatal outcomes.
Methods:
In this multicenter, randomized, double-blind clinical trial conducted from December 2022 to December 2023, 149 women with placenta previa and minor recurrent painless vaginal bleeding were recruited from four maternity teaching hospitals in Iraq and one in Egypt. A total of 149 women were randomized and 146 participants were included in the final analysis. Participants were randomly assigned (1:1) to receive either intravenous TXA or Dextrose 5% in water (placebo). Outcomes included cessation of bleeding after recurrent interventions, gestational age at delivery, and perinatal outcomes.
Results:
TXA was associated with a higher rate of vaginal hemostasis after recurrent intravenous administration compared with placebo (91.8% vs. 53.4%, p<0.001). The TXA group also showed higher rates of live birth with normal Apgar scores (91.8% vs. 42.5%) and normal birth weight (89.0% vs. 49.3%) (p<0.001 for both). Improved hemostasis was accompanied by more favorable gestational outcomes, with higher rates of term delivery (24.7% vs. 2.7%) and lower rates of total preterm delivery (75.3% vs. 97.2%) in the TXA group (p<0.001). Factors significantly associated with hemostasis included TXA use (OR=5.2; 95% CI=1.7–15.5), BMI <25 kg/m² (OR=6.3), and late preterm (OR=20.6) or term delivery (OR=4.5) compared with very preterm delivery.
Conclusions:
In women with placenta previa and minor vaginal bleeding, TXA was associated with higher rates of vaginal hemostasis, longer gestation, and improved neonatal outcomes. Larger studies are needed to confirm these findings and inform clinical practice.
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Copyright (c) 2026 Ariana KH. Jawad, Shahla K. Alalaf, Namir G. Al-Tawil, Kawa Dizaye, Sileem A. Sileem, Noor Elebiary, Zanwer S. Mahmood, Rozhan Y. Khalil, Khalidah M. Ameen, Nazdaar R. Muhammad