Please select the eligibility criteria that correspond to the clinical trial below.
Title: Prophylactic Use of Tranexamic Acid for Preventing Postpartum Hemorrhage: A Randomized, Double-blinded, Placebo-controlled Pilot Trial
Brief Summary: Postpartum hemorrhage (PPH) occurs in up to one in ten deliveries worldwide and is the leading cause of maternal morbidity and mortality. In developing countries 30% of women develop PPH because access to a number of treatments is not readily available. Interestingly, the rate of PPH and consequently of maternal morbidity has increased significantly even in developed nations, such as Canada, over the past decades. This rate is also increasing amongst parturients in Ontario. Unfortunately, few effective preventative treatments exist.

Antifibrinolytic drugs are routinely used to reduce bleeding and the requirement for blood transfusions in a wide range of hemorrhagic conditions. The most commonly used antifibrinolytic drug is tranexamic acid (TXA). TXA is safe, affordable, with very few side effects. The World Health Organization recommended that TXA be used to reduce blood loss in several conditions, including in patients with established PPH refractory to conventional therapy.However, little is known about the prophylactic use of TXA to prevent PPH.


Options:
A: Inclusion Criteria:

* Women admitted to hospital giving birth by CS
* History of at least one risk factor for PPH
* Adult (≥18 years old)

Exclusion Criteria:

* Women giving birth vaginally
* Women with a known allergy to TXA or its excipients
* Women with current antepartum haemorrhage
* Women known to have received TXA within 48 hours prior to randomisation
* Women with known renal impairment
* Women with any known blood clotting disorder
B: Inclusion Criteria:

* gestational age between 37 and 42 weeks,
* live fetus,
* cephalic presentation,
* vaginal birth.
* Patients who had a risk factors for PPH, such as multiple gestation, polyhydramnios, fetal macrosomia, antepartum hemorrhage, anemia (haemoglobin concentration \< 8 g/dL), severe pre-eclampsia, or coagulopathy

Exclusion Criteria:

* placenta previa,
* placental abruption,
* cesarean section or any uterine scar, abnormal placentation (accreta, increta, or percreta),
* a current or previous history of significant disease, including heart disease, liver, renal disorders.
C: Inclusion Criteria:

* 18 years of age or older
* Singleton pregnancy
* Confirmed pregnancy
* Gestational age \>32\^0/7 weeks

Exclusion Criteria:

* Lack of patient consent
* Multiple pregnancy
* History of eclampsia or preeclampsia in current pregnancy
* Imminent Delivery as suspected by any RN or MD involved in delivery care
* History of cardiovascular complications:

  * Coronary artery disease or myocardial infarction
  * Repaired or unrepaired congenital heart disease
  * Vascular disease(s)
  * Severe unstable arrhythmia (e.g. Rapid atrial fibrillation, paroxysmal fibrillation, atrial flutter, etc.)
  * Congestive heart failure
* Contraindication to TXA:

  * History of venous thromboembolism
  * Active thromboembolic disease
  * High risk of thrombosis (e.g. Factor V Leiden or Protein C deficiency)
  * Acquired disturbances of colour vision
  * Allergy to TXA
  * History of seizure disorder
  * Pre-existing hematuria
  * History of renal insufficiency
* Unlikely to comply with follow-up (e.g. no fixed address, plans to move out of town)
* Prisoner status
D: Inclusion Criteria: Women undergoing elective or emergency caesarean section with:

* Estimated gestational age of 37 weeks or more
* Live intrauterine foetus
* Elective or emergency caesarean delivery
* Signed informed consent

Exclusion Criteria:

* History of coagulopathies or conditions predisposing them to thromboembolic phenomena,
* seizure history,
* autoimmune disease,
* placental abruption,
* placenta praevia,
* abnormally adherent placentae if identified on prenatal ultrasound,
* eclampsia or HELLP syndrome,
* known hypersensitivity to TXA,
* planned general anaesthesia,
* caesarean delivery for the second twin or second/third triplet(s) after vaginal birth of the first twin,
* poor understanding of English/Shona languages,
* those who have received anticoagulants in the week before delivery
* persons-under-investigation for Coronavirus disease (COVID-19) and confirmed COVID-19 positive women

Answer: C