Three RCTs were included (n=461, range 100 to 181). Two RCTs scored B for allocation concealment and one scored C. Randomisation method was reported in all trials. There was no blinding in one trial and blinding was not reported in two trials. Participants were followed up for two hours after childbirth in all trials.
The primary outcome of mortality was not reported in any study. Tranexamic acid was associated with a significant reduction in mean blood loss by 92mL (95% CI 76 to 109; three RCTs) compared with control. There was no evidence of heterogeneity. One study reported a lower incidence in postpartum haemorrhage in women who received tranexamic acid compared with control (RR 0.44, 95% CI 0.31 to 0.64).
The most frequently reported adverse event with tranexamic acid was nausea; this was not significant.