Treatment with an antifibrinolytic such as tranexamic acid is known to reduce death from bleeding in patients with trauma and post-partum haemorrhage. Now a new meta-analysis has found strong evidence that even a short delay in treatment reduces the survival benefit from tranexamic acid administration. The data, based on more than 40,000 patients with traumatic or post-partum bleeding, showed:
immediate treatment with tranexamic acid improved survival by more than 70% compared with placebo.
the survival benefit from tranexamic acid decreased by about 10% for every 15 minutes of treatment delay up until 3 hours, after which there was no benefit.
Separation of the normally located placenta before delivery of the fetus. May be concealed or overt.
Frequently presents as vaginal bleeding associated with abdominal pain and contractions in the second half of pregnancy.
Associated with increased perinatal mortality and morbidity. Also a cause of significant maternal morbidity.
Risk factors include smoking, trauma, hypertensive disorders, and cocaine use.
Diagnosis is made clinically. Some ultrasound features may be helpful. Other tests are, for the most part, unreliable.
Management and outcome depend on the gestational age, the degree of separation, and the maternal and fetal status.
The premature separation of a normally located placenta from the uterine wall that occurs before delivery of the fetus.  Abruption may be revealed, when blood escapes through the vagina, or concealed, when the bleeding occurs behind the placenta, with no evidence of bleeding from the vagina.  Abruption may be partial, affecting only part of the placenta, or total, involving the entire placenta.
Atlantic Health System
YO is an author of a number of references cited in this monograph.
Department of Obstetrics and Gynecology
Winthrop University Hospital
Obstetrics, Gynecology, and Reproductive Medicine
Stony Brook School of Medicine
AMV is a consultant for BD (for development of the ODON fetal extraction device).
Professor of Obstetrics and Gynecology
University of Rochester School of Medicine
CG declares that he has no competing interests.
Consultant/Senior Lecturer in Obstetrics and Gynaecology
St George's Hospital
AU declares that he has no competing interests.
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