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haemorrhage
paramedic
medication
clinical skills
paramedic
patient safety

Paramedic management of out-of-hospital postpartum haemorrhage with TXA

02 September 2017
Features
02 September 2017
Volume 9 · Issue 9

Abstract

Background:

As a result of some of the factors discussed within this systematic review, UK Paramedics are more likely to manage postpartum haemorrhage (PPH) within the out-of-hospital setting. This systematic review attempts to address the question: ‘Is it suitable for TXA to be implemented within the UK paramedic management of out-of-hospital PPH?’

Methods:

Randomised control trials (RCTs) focusing on the effect of TXA upon blood loss during PPH were included within this review. A search strategy was created and applied to databases. Critical analysis of the included studies was carried out, and data were presented within tabular format and discussed through the use of narrative synthesis.

Results:

Eight RCTs were included within this systematic review. All studies found a significant reduction in the volume of blood loss during PPH when TXA was administered.

Discussion:

Although TXA was found to significantly reduce the volume of blood loss during PPH, existing evidence is insufficient to support its use within the UK paramedic out-of-hospital management of PPH. Without the presence of studies which are solely focused on the target population, it is difficult to generalise the findings directly to the UK out-of-hospital paramedic management of PPH. This systematic review does however support and supplement the findings of past and current research based upon the relationship between TXA and PPH.

It is important to identify exactly what postpartum haemorrhage (PPH) is and outline its prevalence within health care. Mousa and Alfirevic (2007) explain that the term PPH refers to blood loss greater than 500 mls following vaginal or Caesarean delivery. The RCOG (2009) further categorises PPH into minor (500–1000 mls); major (1000–2000 mls); and severe (>2000 mls) based on the volume of blood lost. They continue to explain that PPH, which occurs within 24 hours of delivery, is known as primary PPH—whereas blood loss that occurs more than 24 hours post delivery is known as secondary PPH. Aiken et al. (2011) detail that 95% of all secondary PPH occurs within the first month of delivery. This can be further subdivided into 19% within 7 days; 41% at 8–14 days; 23% at 15–21 days; and 12% at 22–28 days. In a cohort study based in the UK and comprised of 34 334 women, Fullerton et al. (2013) found that 10% of all women were diagnosed with PPH following their first birth.

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PPH
Postpartum haemorrhage
Tranexamic acid (TXA)
Paramedic
Out of hospital