Prophylactic Tranexamic Acid Administration in Obstetrical Patients to Reduce Postpartum Hemorrhage

Abstract

Problem & Purpose: Postpartum hemorrhage accounts for one of the main causes of death in the maternal population. The postpartum hemorrhage rates at a large acute-care community hospital were higher than the national average at approximately 20%. The literature supports the implementation of a tranexamic acid protocol to significantly reduce the occurrence of hemorrhage in this patient population. The purpose of this quality improvement project was to implement and evaluate the effectiveness of a tranexamic acid protocol for adult obstetrical patients undergoing cesarean section. Methods: The project setting took place in the labor and delivery suite which consisted of two operating rooms. Inclusion criteria were pregnant women 18 years of age or older undergoing elective, non-emergency cesarean sections. Anesthesia providers were educated on the protocol and administration of tranexamic acid. The process measures evaluated included provider compliance to the protocol and assessment of eligible patients. The outcome measure evaluated was the occurrence of postpartum hemorrhage. All data was collected weekly and analyzed via run charts. Results: Over 15 weeks, approximately 65% of providers were compliant in screening patients for eligibility to receive prophylactic tranexamic acid. The patients that met eligibility criteria received prophylactic tranexamic acid 76% of the time. Approximately 71% of women who received tranexamic acid did not experience postpartum hemorrhage. Conclusions: Based on the high adherence rate to the protocol and noticeable difference in postpartum hemorrhage rates, the administration of prophylactic tranexamic acid was a feasible intervention. Overall, there was a reduction in postpartum hemorrhage rates in eligible patients which improved patient outcomes at this institution.