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Dr.Ghada Albatran


postpartum hemorrhage, conservative management, KIWI delivery, tranexamic acid


Introduction: Tranexamic acid is an antifibrinolytic agent typically used in managing hemorrhage. This is the first reported case to use tranexamic acid as the main treatment protocol in secondary PPH in a case with severe vaginal bleeding which would have rather been only managed by surgical intervention.

 Case Presentation: A 38-year-old patient, who had an uncomplicated one pull ventouse KIWI delivery followed by primary PPH of unknown etiology from the common causes. Then ten days post-delivery had secondary PPH with excessive blood loss. Common causes of primary and secondary PPH have been excluded while the only identifiable cause was a bacterial vaginosis; Gardenalia infection detected by high vaginal swap however not sufficient as a main reason to cause such extensive hemorrhage. The case was managed conservatively and medically while avoiding surgical intervention which is usually the inevitable destination of such a case.

Conclusion: In line with the WHO guidelines, we recommend that Tranexamic acid to be considered as a first line treatment of secondary PPH regardless of the etiology. Although treating the cause is a must, but commencing Tranexamic acid with continuous administration until the hemorrhage completely settles is a strong recommendation to control the bleeding and avoid the progression to severe blood loss where hysterectomy or other surgical or radiological interventions will be the remaining treatment options.

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