In the management of atonic primary postpartum hemorrhage unresponsive to oxytocin and ergometrine, tranexamic acid is administered. The WOMAN trial (2017) evaluated its use. Which of the following accurately reflects the trial's primary finding?

• A Tranexamic acid significantly reduced the need for hysterectomy in all PPH cases
• B Tranexamic acid reduced all-cause maternal mortality but increased thrombotic events
• C Tranexamic acid showed no benefit in death from PPH but was safe
• D Tranexamic acid significantly reduced maternal mortality from PPH when given within 3 hours of birth ✓

Explanation

The WOMAN trial (20,060 women across 21 countries) found that tranexamic acid significantly reduced death due to PPH (RR 0.81) when given within 3 hours of delivery, with no increase in thromboembolic events. The benefit was greatest when given early (within 1 hour). It did not significantly reduce hysterectomy rates overall. This established tranexamic acid as a third-line uterotonic adjunct in WHO and FIGO PPH protocols, to be given as early as possible.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.