The WOMAN trial (2017) evaluated tranexamic acid in postpartum haemorrhage. Which of the following best summarises its key finding regarding mortality from PPH?

• A Tranexamic acid given within 3 hours of delivery significantly reduced all-cause maternal mortality
• B Tranexamic acid reduced uterotonic drug requirements but did not affect mortality
• C Tranexamic acid was beneficial only when given prophylactically before PPH onset
• D Tranexamic acid given within 3 hours of PPH onset significantly reduced deaths from bleeding without increased thromboembolic events ✓

Explanation

The WOMAN trial (Lancet 2017) enrolled 20,060 women with PPH and showed that tranexamic acid given within 3 hours of delivery significantly reduced deaths due to bleeding (relative risk 0.81) without increasing thromboembolic complications. The benefit was specifically for haemorrhage-specific death; all-cause mortality was not significantly changed. Critically, benefit diminished and was absent when given after 3 hours. This trial led to TXA being universally recommended in WHO and national PPH management protocols.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.