Tranexamic Acid in Pregnant Women With Placenta Previa: A Double-Blind, Multicenter Randomized Clinical Trial

Aims: To determine the effectiveness of tranexamic acid (TXA) in reducing vaginal bleeding, extending pregnancy duration, and enhancing perinatal outcomes in pregnant women with placenta previa. Methods: A multicenter, randomized, double-blind clinical trial was conducted at three maternity teaching hospitals in Iraq's Kurdistan region, Azadi Hospital in the north of Iraq, and Al-Azhar University Hospital in Egypt on 146 women with placenta previa. Participants were randomly assigned to two interventional groups in a 1:1 ratio to receive either TXA or Dextrose 5% water (D5W). The two groups were compared in terms of the cessation of vaginal bleeding, continuation of pregnancy to term, and the perinatal outcome after repeated use of either method of treatment. Results: Bleeding stopped in 91.8% of the TXA group; however, the placebo group had more admissions for blood transfusion, received more units of packed red blood cells, and almost all their deliveries were preterm compared with the TXA group. Factors significantly associated with 'stopped bleeding' were TXA (OR = 5.2; 95% CI = 1.7-15.5), BMI of < 25 kg/m2 (OR = 6.3; 95% CI = 1.2-35.5), and BMI of 25-29 kg/m2, late preterm delivery (32-36+6 weeks) [OR = 20.6; 95% CI = 4.6-90.2], and term delivery (39-40+6 weeks) [OR = 4.5; 95% CI = 4.5-776.2] compared with very preterm deliveries (28-32+6 weeks). Conclusions: Treatment with TXA during pregnancy in women with placenta previa significantly outperforms in managing vaginal bleeding, prolonging pregnancy to a favorable gestational age and perinatal outcome. Larger studies are needed to confirm its benefits and guide clinical practice.