The Effect of Tranexamic Acid Administration Timing on Maternal and Neonatal Outcomes During Cesarean Delivery

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

The administration of tranexamic acid (TXA) during cesarean delivery is a non-standardized strategy used to reduce the risk and severity of postpartum hemorrhage. The ideal timing of administering TXA is surgeon dependent with the goal to give it early enough to decrease the rates of hemorrhage, while also minimizing the risks of medication exposure to the fetus. Although adverse events caused by TXA are rare, they include seizures and thrombosis. This study aims to evaluate the impact of TXA administration timing on maternal and neonatal outcomes during cesarean delivery.

This retrospective cohort study evaluated 19,340 cesarean deliveries from 2022 to 2025 to test the hypothesis that TXA administration prior to umbilical cord clamping reduces quantified blood loss (QBL) without increasing neonatal complications. Data from 4,004 deliveries with TXA administered prior to cord clamping, 3,486 deliveries with TXA administered post-cord clamping, and 11,850 deliveries without TXA were analyzed. Primary outcomes included QBL, neonatal complications (seizure, intracranial hemorrhage, death), and NICU admission rates.

TXA administration prior to umbilical cord clamping was associated with a 23.7% lower median QBL (Median: 683 mL [IQR: 485, 1000]) compared to patients who received TXA after cord clamping (Median: 895mL [IQR: 600, 1304]) (Wilcoxon Rank Sum p < 0.0001). Compared to patients with no TXA administration, those who received TXA prior to cord clamping had a 3.1% lower rate of overall newborn injury (95% CI: 2.3%, 4.1%; Chi-square p < 0.0001) and no significant differences in the rates of seizure (p = 0.8897), intracranial hemorrhage (p = 0.1555), or death (p = 0.8083). TXA administration prior to cord clamping was associated with a 2.1% higher NICU admission rate (95% CI: 1.0%, 3.2%; Chi-square p = 0.0001).

TXA administration prior to umbilical cord clamping during cesarean delivery significantly reduces quantified blood loss without increasing the risk of major neonatal complications. However, it is associated with a higher rate of NICU admissions. These results speak to the maternal benefits of TXA administration prior to cesarean delivery to reduce the risk of postpartum hemorrhage while posing minimal to no risk to the fetus.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1876

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