The WOMAN trial (Lancet 2017) evaluated tranexamic acid (TXA) in PPH. Which of the following best summarizes its primary finding?

• A TXA reduced death due to bleeding by 31% when given within 3 hours, with no increase in thromboembolic events ✓
• B TXA reduced all-cause maternal mortality by 30% when given within 3 hours of PPH onset
• C TXA reduced hysterectomy rates by 40% but had no effect on mortality
• D TXA given within 1 hour of delivery prevented PPH but showed no benefit after PPH was established

Explanation

The WOMAN trial (World Maternal Antifibrinolytic Trial) enrolled over 20,000 women with PPH and found that tranexamic acid significantly reduced death due to bleeding by 31% (RR 0.69, 95% CI 0.52–0.91) when given within 3 hours of delivery; the benefit was time-dependent and lost when given after 3 hours. There was no significant increase in thromboembolic complications. Overall all-cause mortality was not significantly reduced, but death from bleeding specifically was. This trial established the 3-hour window as critical for TXA efficacy in PPH and led to WHO recommendation of early TXA administration.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.