Tranexamic acid for the prevention of postpartum hemorrhage in women undergoing cesarean delivery.

We read with interest the meta-analysis performed by Bellos and Pergialotis.1 The authors included 36 randomized controlled trials involving 10,659 women. The authors judged that none of the included trials were at a high risk of bias, with 21 (58.3%) trials judged to be at a low risk and 15 (41.7%) trials to be at a moderate risk of bias; the remainder were rated as unclear. The fact that no trials were judged to be at a high risk of bias was included as a strength of the meta-analysis and apparently informed the conclusions. We, however, strongly disagree.