Post-partum hemorrhage is characterized by a cumulative blood volume loss (encompassing both intrapartum and postpartum bleeding) equal to or exceeding 500 ml subsequent to a vaginal delivery, or 1000 ml following a cesarean delivery. Alternatively, it includes blood loss accompanied by clinical manifestations of hypovolemia, such as increased heart rate, low blood pressure, rapid breathing, reduced urine output, dizziness, pallor, or changes in mental alertness, all occurring within 24 hours of the childbirth process. Worldwide post-partum hemorrhage accounts for 27% of maternal deaths. Some countries have reported this figure as high as 60%. It is the most important cause of maternal mortality & morbidity especially in the middle and low income countries. In India, deaths due to PPH were reported to be 38%(RGI-SRS 2001-2003). Some of the risk factors contributing to the occurrence of Post partum hemorrhage include Body Mass Index (BMI) >35, anemia (Hb <10.5g/dl), leiomyomas, adenomyosis, induced labor, labor prolonged >12hours, oxytocin use, multiple pregnancies, parity >5, polyhydramnios, fetal macrosomia (>4Kg), history of PPH, history of previous cesarean section and placenta previa. It is crucial to emphasize that the existence of these risk factors does not assure the occurrence of PPH; however, they might elevate the probability. Top of FormIdentifying these risk factors and implementing appropriate preventive measures, including close monitoring during labor, judicious use of interventions, and readiness to manage complications, can contribute to the prevention and effective management of postpartum hemorrhage.

This research endeavor seeks to execute a randomized, double-blind, non-inferiority trial, to assess and compare the effectiveness of prophylactic tranexamic acid administered at two distinct time points in reducing blood loss. The overarching aim is to ascertain the optimal timing for the administration of tranexamic acid to prevent post-partum hemorrhage (PPH) in cesarean deliveries.