Please select the eligibility criteria that correspond 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: 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.
B: 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
C: Inclusion Criteria:

* : adult women admitted for a cesarean delivery before or during labor, at a term ≥ 34 weeks,
* hemoglobin level at the last blood sample \>9g/dl,
* available blood test for Hb and Ht within one week before caesarean delivery,
* informed signed consent

Exclusion Criteria:

* previous thrombotic event or preexisting pro-thrombotic disease,
* epileptic state or history of seizures,
* presence of any chronic or active cardiovascular disease outside hypertension,
* any chronic or active renal disease and chronic or active liver disease at risk thrombotic or hemorrhagic, autoimmune disease,
* sickle cell disease,
* placenta praevia,
* placenta accreta/increta/percreta,
* abruption placentae,
* eclampsia,
* HELLP syndrome,
* significant hemorrhage before cesarean section
* in utero fetal death,
* administration of low-molecular-weight heparin or antiplatelet agents during the week before delivery,
* planned general anesthesia,
* hypersensitivity to tranexamic acid or concentrated hydrochloric acid,
* instrumental extraction failure,
* multiple pregnancy with vaginal delivery of the first child,
* poor understanding of the French language.
D: Inclusion Criteria:

* Pregnant women candidate for LSCS.
* Age: 20-40 years old.
* Full term pregnancies (\> 37 weeks confirmed by the 1st day of the LMP or 1st trimesteric ultrasound scan).
* Singleton or twin pregnancies.
* Maternal Anemia (hemoglobin \< 9.9 g%)
* Maternal medical disorders (e.g. cardiac, renal, and hepatic diseases, Thromboembolic disorders or coagulopathies).
* High risk case for obstetric hemorrhage (e.g. peripartum hemorrhage, accidental hemorrhage, placenta previa, previous history of uterine atony or postpartum hemorrhage).
* CS under spinal anesthesia.

Exclusion Criteria:

* Fetal death (IUFD).
* Fetal anomalies or IUGR (estimated fetal weight below the 5th centile)
* Women attending for emergency CS.
* More than 2 previous CS procedures.
* Prolonged procedure (more than 2 hours from skin incision to skin closure).
* History of prostaglandin or Tranexamic acid allergy.

Answer: A