Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: N/A
Brief Summary: Obstetrical hemorrhage accounts for nearly one quarter of all maternal deaths worldwide and was the most common cause of maternal death in the Turkey \[1,2\]. Most of these deaths occur within 4 h of delivery and are a result of problems during third and fourth stages of labor. It also contributes significantly to serious maternal morbidity. Obstetric, surgical and radiological interventions play central role in the management of obstetric hemorrhage; however, pharmacologic management and in particular prohemostatic therapies also play an important role in the final maternal outcome. Administration of tranexamic acid (TA), intravenously in the third stage of labor may be one of these methods.

TA a synthetic derivate of the amino acid lysine, is an antifibrinolytic that reversibly inhibits the activation of plasminogen, thus inhibiting fibrinolysis and reducing bleeding. TA may enhance the effectiveness of the patient's own hemostatic mechanism \[3,4\]. In nonobstetric surgery, a systematic review of randomized controlled trails showed that tranexamic acid reduced the risk of blood transfusion \[ relative risk (RR) 0.61; 95% CI 0.54-0.69\] and also reduced the need for re-operation as a result of bleeding (RR 0.67; 95% CI 0.41-1.09). There was no evidence for an increased risk of thrombotic events \[5\].

In gynecology and obstetrics, TA is most commonly used to treat idiopathic menorrhagia, and is an effective and well-tolerated treatment when administered orally \[5,6,7\]. Bleeding associated with pregnancy (placental abruption, placenta previa) has also been treated with TA \[6\]. Furthermore, four randomized controlled studies have shown that TA reduces postpartum hemorrhage (PPH) following cesarean delivery \[7-11\]. Only one randomized trail is available evaluating the effect of TA use to prevent bleeding in the postpartum period following spontaneous vaginal delivery \[12\].

The purpose of our study was to estimate the effect of the addition of intravenous TA to a standard active management of the third stage of labor (which includes prophylactic injection of 10 IU of oxytocin within two minutes of birth, early clamping of the umbilical cord, and controlled cord traction).


Options:
A: Arm Label: tranexamic acid; Type: ACTIVE_COMPARATOR; Interventions: Drug: transamin | Arm Label: saline; Type: NO_INTERVENTION; Interventions: N/A | Intervention Type: DRUG; Name: transamin; Assigned to Arm(s): tranexamic acid
B: Arm Label: Intravenous tranexamic acid; Type: EXPERIMENTAL; Interventions: Drug: Tranexamic Acid 100Mg/Ml Inj Vil 10Ml | Arm Label: Intramuscular tranexamic acid; Type: EXPERIMENTAL; Interventions: Drug: Tranexamic Acid Injectable Product | Arm Label: Oral liquid tranexamic acid; Type: EXPERIMENTAL; Interventions: Drug: Tranexamic Acid Oral Solution | Arm Label: No tranexamic acid; Type: NO_INTERVENTION; Interventions: N/A | Intervention Type: DRUG; Name: Tranexamic Acid 100Mg/Ml Inj Vil 10Ml; Assigned to Arm(s): Intravenous tranexamic acid | Intervention Type: DRUG; Name: Tranexamic Acid Oral Solution; Assigned to Arm(s): Oral liquid tranexamic acid | Intervention Type: DRUG; Name: Tranexamic Acid Injectable Product; Assigned to Arm(s): Intramuscular tranexamic acid
C: Arm Label: Tranexamic acid; Type: EXPERIMENTAL; Interventions: Drug: Tranexamic Acid Injectable Solution | Arm Label: Chloride solution; Type: PLACEBO_COMPARATOR; Interventions: Drug: Sodium Chloride 0.9% | Intervention Type: DRUG; Name: Tranexamic Acid Injectable Solution; Assigned to Arm(s): Tranexamic acid | Intervention Type: DRUG; Name: Sodium Chloride 0.9%; Assigned to Arm(s): Chloride solution
D: Arm Label: Tranexamic group; Type: ACTIVE_COMPARATOR; Interventions: Drug: Tranexamic acid | Arm Label: Misoprostol group; Type: ACTIVE_COMPARATOR; Interventions: Drug: Misoprostol | Arm Label: oxytocin only group; Type: ACTIVE_COMPARATOR; Interventions: Drug: Oxytocin | Intervention Type: DRUG; Name: Misoprostol; Assigned to Arm(s): Misoprostol group | Intervention Type: DRUG; Name: Tranexamic acid; Assigned to Arm(s): Tranexamic group | Intervention Type: DRUG; Name: Oxytocin; Assigned to Arm(s): oxytocin only group

Answer: A