A Review of Guidelines for the Use of Tranexamic Acid in the Management of Postpartum Hemorrhage and Assessment of Associated Maternal Outcomes.

Postpartum hemorrhage (PPH) remains a major cause of maternal morbidity and mortality worldwide, requiring rapid recognition and coordinated hemostatic intervention. Tranexamic acid (trans-4-aminomethylcyclohexane-1-carboxylic acid; TXA), an antifibrinolytic agent that inhibits plasminogen-mediated fibrin degradation, has emerged as an important component of PPH management. Despite growing evidence supporting TXA, recommendations on its timing and placement within PPH treatment algorithms vary across major international guidelines. This narrative review examines the pharmacology, clinical indications, safety profile, and therapeutic role of TXA in PPH. It evaluates evidence supporting TXA in obstetric and non-obstetric hemorrhage, compares its role with other hemostatic therapies, and critically examines recommendations from major international and national organizations. It pays particular attention to differences in how these guidelines position TXA within PPH treatment pathways and integrate it with other first-response interventions. This review also considers uncertainties around prophylactic use, alternative hemostatic therapies, and variation in guideline implementation. Greater consistency in evidence-based recommendations may clarify TXA's role in contemporary PPH management while allowing flexibility for differences in healthcare settings and resources.