5) External Validity: The vast majority of these patients came from developing countries. It is unclear what resources their health care system had to address PPH compared to the United States and if these results could be applied to our health care system.

Bottom Line

This study does not provide good evidence that TXA improves survival in women with PPH.

Case Resolution

The fundal massage and oxytocin seem to work, and the bleeding slows. The patient is still hemodynamically stable when the obstetrical team arrives. She is transferred to the postpartum unit for further management and does not receive TXA.

Thank you to Nick Papalia, MD, who is currently completing his third year of obstetrics and gynecology residency at the University of Calgary in Alberta, for his help with this review.

Remember to be skeptical of anything you learn, even if you heard it on the Skeptics’ Guide to Emergency Medicine

References

1. Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6):e323-33.
2. Committee on Practice Bulletins-Obstetrics. Practice bulletin no. 183: postpartum hemorrhage. Obstet Gynecol. 2017;130(4):e168-e186.
3. Nickson C. Fragility index. Life in the Fast Lane website. Accessed June 20, 2018.
4. Fragility index calculator. ClinCalc website. Accessed June 20, 2018.