The Role of Perinatal Nurses in the Use of Tranexamic Acid During Postpartum Hemorrhage.

Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide. Mitigation of PPH is dependent on identification of risk, readiness, timely identification of hemorrhage, accurate determination of blood loss, and effective treatment. Perinatal nurses must be prepared to participate in all these aspects of care, including the use of tranexamic acid, an antifibrinolytic agent that has more recently been added to the pharmacologic agents used to reduce blood loss associated with hemorrhage. The purpose of this article is to identify the nurse's role in the management of PPH and to introduce the use of tranexamic acid in PPH management as part of the nurse's role in implementing best practices for PPH.

Case Report of the Management of Milk Blebs.

The formation of a milk bleb during breastfeeding is frequently associated with nipple pain that may affect the breastfeeding success of the mother-infant dyad. Early cessation of breastfeeding may occur when pain is ongoing. Timely evaluation and diagnosis and effective management are imperative to prevent tissue damage and lingering symptoms. In this case report, we evaluate the unique challenges of the diagnosis and management of milk blebs, including nonpharmacologic and pharmacologic treatment.

The Use of Tranexamic Acid to Prevent Postpartum Hemorrhage.

Tranexamic acid (TXA) is an antifibrinolytic pharmacologic agent with demonstrated effectiveness for reducing the incidence of death from blood loss following trauma and major surgery. In intrapartum care, TXA is being used in in conjunction with uterotonic agents to treat postpartum hemorrhage (PPH). Based on the findings of the WOMAN trial that found TXA reduced maternal death due to PPH, the World Health Organization recommends that TXA be part of the standard comprehensive PPH treatment package, and US professional organizations recognize its use as adjunctive treatment for PPH. Evidence suggests that TXA used prophylactically in the setting of cesarean birth may decrease blood loss and the incidence of PPH. There is limited evidence for prophylactic use of TXA in women of all risk categories following vaginal birth but prophylactic use in women who have an a priori risk for PPH is being investigated. This article presents a case in which a midwife identifies a woman in active labor who has significant risk factors for PPH. In consultation with the collaborating obstetrician, TXA is given early during the third stage of labor in addition to the recommended components of active management for the purpose of preventing PPH.