Search Results (43,495)

Background/Objectives: Despite well-documented chemical and physical hazards in healthcare settings, existing reviews of occupational reproductive risks have largely focused on single-agent risk estimation and have rarely translated occupational hygiene evidence into clinical decision-making frameworks for reproductive counseling and surveillance. This narrative review synthesizes evidence across multiple occupational exposure categories—antineoplastic agents, high-level disinfectants (HLDs), sterilants, and work-organization factors—and proposes an integrated, clinically operational framework for preconception counseling, pregnancy-sensitive risk stratification, exposure-control verification, and reproductive health surveillance among women healthcare workers. Methods: A structured narrative literature search was conducted across PubMed/MEDLINE, Scopus, Web of Science, and Embase from database inception through January 2025 and updated in March 2026. The review was guided by a Population–Exposure–Comparison–Outcome (PECO) framework and structured using Search–Appraisal–Synthesis–Analysis (SALSA) principles and the Scale for the Assessment of Narrative Review Articles (SANRA). Evidence quality was summarized using a modified hierarchy-of-evidence classification provided as a reader aid. This narrative review employed structured transparency tools but does not claim the methodological status of a systematic review. Quantitative meta-analytic pooling was not performed owing to substantial heterogeneity across study designs, exposure assessment methods, and outcome definitions; findings were synthesized narratively by exposure category. Results: The strongest and most consistent evidence was identified for occupational exposure to antineoplastic agents, which has been associated with spontaneous abortion, stillbirth, congenital abnormalities, impaired fecundability, and selected cancer-related concerns. HLDs and sterilants represent exposure categories warranting precautionary attention, with some evidence suggesting possible adverse effects on fecundability and early pregnancy maintenance; however, findings are considerably more heterogeneous, context-dependent, and reliant on self-reported exposure assessment than those for antineoplastic agents. Broader workplace factors, including shift work, prolonged working hours, physical workload, and mixed exposures, may further contribute to reproductive risk. The synthesis supports task-specific occupational history taking, exposure-control verification, and pregnancy-sensitive risk stratification. Conclusions: This review provides a multi-exposure, clinically operational framework that bridges occupational hygiene evidence with reproductive healthcare delivery, offering practical decision-support tools for clinicians managing women healthcare workers during preconception, pregnancy, and lactation. The framework includes structured occupational history-taking questions, a clinical decision pathway with evidence-tier classification, and a prevention matrix linking exposure sources to workplace controls and clinical actions. Integrating task-specific occupational history taking into routine reproductive care may improve detection of preventable workplace risks and support timely accommodation, while clinicians should calibrate recommendation strength to the underlying evidence quality for each exposure category. Full article

Background/Objectives: This cohort study aims to evaluate the association between antenatal blood pressure levels and postpartum cardiovascular outcomes in women with preeclampsia and/or fetal growth restriction (FGR). The objective of the study was to test the hypothesis that blood pressure levels during pregnancy are associated with cardiovascular health after delivery. Methods: The study was conducted at a tertiary hospital in Germany and involved women who developed preeclampsia and/or FGR during their pregnancies between 2021 and 2024. Participants were invited for cardiovascular follow-up consultations at 6 weeks and 6 months postpartum. VICORDER measurements were used for cardiovascular function assessment. Results were compared between the group with persisting hypertension and normotensive women at each study visit to assess the long-term progression of hypertensive disorders in relation to antenatal blood pressure levels. Statistical analysis employed Mann–Whitney U tests and adjusted odds ratios (aORs). Results: Of the 103 women who attended postpartum cardiovascular consultations during the study period, a substantial proportion still had elevated blood pressure at 6 weeks (51.49%) and 6 months (42.86%) after delivery. Women with persistent hypertension had higher systolic and diastolic blood pressure throughout pregnancy (p < 0.001), used antihypertensive medication more frequently (p < 0.001) and showed significantly increased arterial stiffness up to 6 weeks postpartum compared with normotensive women (7.4 m/s vs. 6.7 m/s, p < 0.001). In adjusted analyses, higher blood pressure levels during pregnancy were significant predictors of persistent postpartum hypertension (p < 0.05). Except for systolic blood pressure in the 3rd trimester at the 6-week follow-up, every 10 mmHg increase in blood pressure during pregnancy was associated with higher odds of postpartum hypertension, with aORs ranging from 1.82 to 3.42 at 6 weeks and from 2.18 to 5.51 at 6 months postpartum (depending on the trimester). Conclusions: Maintaining healthy blood pressure levels during pregnancy may reduce the long-term cardiovascular risk for mothers. These findings underscore the importance of early detection and consistent management of hypertension in expectant mothers with hypertensive pregnancy disorders. Further research is required to identify optimal blood pressure management strategies during pregnancy that could improve immediate and long-term maternal health outcomes. Full article

South Africa’s public hospital system faces mounting pressure from ageing infrastructure, rising patient demand, and constrained maintenance budgets. While significant investment has been directed toward the construction of new healthcare facilities, the diffusion and adoption of advanced technologies within operations and maintenance (O&M) remain uneven and underdeveloped. This misalignment limits the long-term performance, safety, and sustainability of hospital assets. This study investigates technological diffusion within the O&M environment of a newly commissioned 500-bed regional hospital in Durban, KwaZulu-Natal. A qualitative single-case study approach was adopted, drawing on semi-structured interviews with 14 stakeholders across project delivery and facility management functions. Data were analysed thematically to identify systemic patterns and operational constraints. Findings reveal a persistent reliance on manual, reactive maintenance practices, with minimal integration of digital tools, including building management systems, predictive maintenance technologies, and real-time monitoring platforms. Key barriers include unclear institutional roles, inadequate handover processes, limited technical capacity, and the absence of strategic leadership to drive innovation. A critical disconnect was also identified between managerial expectations and operational realities. The study argues that technological adoption in hospital O&M is not merely a technical challenge but an institutional one. It recommends targeted capacity development, structured transition frameworks, and stronger governance mechanisms to enable sustainable digital integration. Full article

We conducted a theoretical analysis on the diffusiophoretic motion of a dielectric droplet in a cylindrical pore in the presence of an induced diffusion potential, such as that in a NaCl electrolyte solution. The fundamental electrokinetic governing equations are solved using a patched pseudo-spectral method based on Chebyshev polynomials, coupled with a geometric mapping scheme to handle the irregular solution domain. The impact of the boundary confinement effect on droplet mobility is examined in detail. Interesting electrokinetic phenomena are found in this work, such as mobility reversal in narrow cylindrical pores with the droplet moving against the direction expected based on the classical Coulomb electrostatic law due to the strong boundary confinement effect. Moreover, “solidification phenomenon” is also found at some specific pore radius where the droplets move as rigid particles with no interior recirculating vortex flows regardless of the droplet viscosities. Corresponding critical points of ${\mathrm{R}}_{\mathrm{w}}^{\mathrm{*}}$, the ratio of droplet radius to the cylindrical radius are found where the spinning orientation on the droplet surface changes each time as it passes them. The profound boundary confinement effect, both electrostatically and hydrodynamically, is responsible for these peculiar phenomena. The results presented here have direct applications in microfluidic and nanofluidic operations as well as drug delivery applications. Full article

According to data from the World Federation of Societies of Anesthesiologists, numerous countries across Asia and Africa have fewer than one anaesthesiologist per 100,000 people. Upskilling nurse anaesthetists in these regions is critical to improving clinical outcomes, and interactive virtual patient simulators offer a safe environment to explore complex clinical scenarios. This paper introduces an advanced general anaesthesia patient simulator engineered to bridge the accessibility gap left by existing platforms, which often require expert programming knowledge and restrict users to manual titration. Our simulator features an intuitive graphical user interface optimised for clinical education and natively supports both manual and closed-loop anaesthesia administration. The platform includes a suite of pre-designed controllers, specifically standard PIDs and two distinct fractional-order FO-PID variants, highlighting a novel robust FO-PID framework engineered to mitigate high patient variability. The deployment of these embedded controllers is demonstrated via a Depth of Hypnosis regulation case study and validated across a diverse cohort of 19 virtual patients. Closed-loop evaluation reveals that while the standard PID achieves a lower average mean squared error during the maintenance phase, the fractional-order alternatives deliver significantly superior robustness and inter-patient consistency. Ultimately, integrating this simulator into clinical training frameworks offers a viable pathway to reduce nursing workload and enhance patient safety through optimised automated drug delivery. Full article

The immune response is essential in the protection of our body against pathogens; however, the inflammatory response caused by the immune system can become a disease itself. In fact, anti-inflammatory and immune-suppressive drugs are applied to limit the immune response to treat inflammatory diseases. Flavonoids are plant-derived polyphenols extensively investigated for their anti-inflammatory and antioxidant properties in inflammatory diseases. Studies applying isolated compounds as well as using supplements as nutraceuticals based on flavonoids have been conducted. Our review systematically analyzed the top five studied flavonoids between 2020 and 2025: quercetin (1742 articles), kaempferol (642), luteolin (589), apigenin (419), and epicatechin (354), highlighting their major therapeutic applications in diseases affecting the liver (12%), nervous system (11%), and lungs (10%). Mechanistically, these compounds act as multi-target agents mainly by inhibiting NF-κB and inducing Nrf2-dependent antioxidant programs. Application of advanced delivery systems, which increase oral bioavailability by up to 20-fold, overcomes pharmacokinetic bottlenecks. Clinical highlights demonstrated promising therapeutic effects, including reduced intrahepatic lipid accumulation in non-alcoholic fatty liver disease patients following quercetin supplementation (11.5% to 9.6%) and accelerated SARS-CoV-2 clearance after quercetin phytosome administration. The translation of flavonoids into standardized clinical therapies remains limited by the lack of large-scale, well-controlled clinical trials. Full article

This study aimed to determine the absolute bioavailability of quercetin and quantitatively evaluate its pharmacokinetic–pharmacodynamic (PK-PD) relationship regarding acute glucose-lowering effects in normoglycemic and alloxan-induced diabetic rats, addressing whether its in vivo efficacy is driven by the free aglycone or its biotransformed intermediates. Healthy and diabetic rats received single doses of quercetin either orally (75 mg/kg) or intravenously (38 mg/kg). Plasma concentrations of free quercetin were quantified using a validated HPLC-DAD method, and temporal PK-PD relationships between systemic exposure and the percentage variation of glycemia were mathematically evaluated employing Pearson correlation analysis. The absolute bioavailability of free quercetin was significantly impaired by the pathophysiological state, dropping from 59.7% in healthy rats to 40.9% in diabetic subjects. Despite this diminished systemic exposure, oral administration elicited significant hypoglycemic responses. Crucially, the Pearson correlation analysis revealed a pronounced temporal dissociation: the onset of glycemic reduction occurred independently of the maximal circulating concentration of free quercetin. Furthermore, intravenous delivery bypassed first-pass barriers and induced a markedly faster and deeper hypoglycemic effect (up to −47% in diabetic rats). Finally, the diminished bioavailability under diabetic conditions and the stark PK-PD temporal dissociation strongly suggest that quercetin’s acute antihyperglycemic effect is driven by rapid hepatic Phase II biotransformation, implicating conjugated metabolites (rather than the free aglycone) as the principal pharmacological effectors. Full article

Commercially available graphene quantum dots (GQDs) are promising nanomaterials for applications in research and preclinical diagnostics, drug delivery, and bioimaging. Their bioactivity is highly dependent on dose, route of exposure, duration, cell type, uptake mechanisms, tissue and cellular distribution, and physicochemical properties. This study aimed to evaluate genotoxic, cytotoxic, and cytostatic endpoints of blue- (B-GQDs) and green-emitting (G-GQDs) GQDs in human blood and salivary leukocytes. GQDs were tested at concentrations ranging from 2.5 to 100 µg/mL using distinct treatment periods. Fourier transform infrared spectroscopy (FTIR), trypan blue exclusion, comet, and cytokinesis-block micronucleus cytome (CBMN cyt) assays were performed. FTIR analysis revealed that G-GQDs, unlike B-GQDs, exhibit an absorption band typically associated with amine functional groups, which may contribute to their pronounced genotoxic effects. Peripheral blood mononuclear cells and salivary leukocytes showed higher sensitivity to G-GQDs compared to whole blood samples. Although no cytotoxic effects were observed, both GQDs induced significant DNA damage, with G-GQDs demonstrating greater genotoxic potential. These findings demonstrate that GQDs can induce DNA damage in the absence of detectable cytotoxic effects under the conditions tested, highlighting the importance of considering both physicochemical properties and cellular models in the safety assessment of nanomaterials. Full article

Objectives: To address the critical limitations of current formulations that fail to simultaneously resolve indomethacin’s poor water solubility, susceptibility to gastric acid hydrolysis, and difficulty in balancing rapid onset with long-term sustained release, this study prepared solid dispersions via anti-solvent freeze-drying to improve drug dissolution, constructed oral buccoadhesive bilayer controlled-release tablets using direct powder compression, and elucidated the intrinsic relationships among polymer gel properties, swelling-erosion behavior, tablet integrity maintenance, and drug release mechanisms. Methods: Solid dispersions (SDs) were prepared by anti-solvent freeze-drying. Bilayer tablets (25 mg IND/tablet, 12.5 mg/layer) were fabricated via direct powder compression after optimizing disintegrants and polymer matrices. In vitro dissolution, surface pH, adhesion time, and adhesion strength were evaluated. Results: SDs enhanced dissolution by at least 30-fold in water and 2.4-fold at pH 6.8 within 2 h versus pure drug. Optimized bilayer tablets achieved 45% drug release at 20 min and 80% sustained release over 8 h, with surface pH of 6.8 ± 0.1, adhesion time of 8.3 ± 0.1 h, and adhesion strength of 57 ± 0.13 g. Conclusions: The physicochemical properties of polymeric excipients are critical for balancing drug release and mucoadhesion in buccal tablets. To achieve ideal controlled-release effects, in addition to focusing on the swelling and erosion characteristics of matrix-based tablets, the ability to maintain tablet integrity during dynamic dissolution must be further investigated, which is an essential factor for ensuring precisely modulated drug release. Meanwhile, when employing solid dispersions as solubilizing intermediates to prepare controlled-release formulations, the gelling properties of polymers in each formulation component should be fully considered to avoid incomplete disintegration and insufficient release at the initial dissolution stage. Full article

Background/Objectives: The recent approval of the first intranasal calcitonin gene-related peptide receptor antagonist (CGRP-RA), zavegepant, has increased the relevance of this drug class in treating acute migraine. However, introducing an alternative delivery method may result in a different real-world safety profile. Thus, the aim of this study was to assess adverse events (AEs) related to zavegepant through a retrospective pharmacovigilance disproportionality analysis. Methods: We analyzed Individual Case Safety Reports (ICSRs) presenting zavegepant as the suspected drug, submitted to the Food and Drug Administration (FDA) Adverse Event Monitoring System (AEMS) database between 1 January 2023 and 31 December 2025. ICSRs were assessed by using descriptive and disproportionality analyses. Reporting odds ratios (RORs) with 95% confidence intervals (CIs) were used as disproportionality measures. Results were deemed significant if the ROR 95% CI lower bound was >1 and ≥3 ICSRs were available for each drug–event pair. Results: A total of 509 zavegepant-related ICSRs were identified. Most ICSRs involved female patients (n = 353; 69.4%), with a median (quartile 1, Q1–quartile 3, Q3) age of 45 (34–56) years. The Medical Dictionary for Regulatory Activities (MedDRA^®) Preferred Terms with the highest RORs were nasal discomfort (n = 62; ROR = 298.85; 95%CI [228.91, 390.17]), rhinalgia (10; 126.09; [67.34, 236.09]), dysgeusia (147; 94.72; [78.19, 114.75]), pharyngeal ulceration (3; 79.20; [25.42, 246.75]), and upper-airway cough syndrome (16; 62.87; [38.19, 103.49]). Conclusions: These results suggest a safety profile for zavegepant consistent with previous knowledge regarding CGRP-RAs. However, nasal and/or oropharyngeal AEs, plausibly related to intranasal exposure, may affect perceived tolerability and timely use, warranting further investigation. Full article

Background: Clear post-extraction sessions are vital for good patient outcomes. Traditional methods, such as verbal and printed information, have historically been prevalent; however, digital health care methods for analysis and communication are increasingly being adopted. Still, evidence comparing preferences for digital versus traditional instruction, especially for routine post-extraction care, remains limited. Objectives: This study aimed to evaluate preferences between digital methods (QR code-based videos) and traditional methods (verbal and printed leaflets) for delivering post-extraction care instructions among dental patients and students. It also assesses perceptions of communication quality, confidence, and patient interaction associated with each method. Methods: A cross-sectional study involved 200 dental students and 200 patients undergoing routine tooth extractions. The sample size was determined based on a 5% margin of error at a 95% confidence level for proportion estimation. Participants experienced all three instructional delivery methods—verbal, printed leaflet, and QR code-based video—for post-extraction care and completed validated questionnaires. The study assessed preferences for each delivery method, communication quality, confidence in following or providing instructions, ease of access, perceived usefulness, and impact on patient-provider interaction. Data were analyzed using descriptive statistics, the Mann–Whitney U test for group comparisons, and Spearman correlation for relationships among ordinal data. Results: Among all participants, 67.5% chose QR codes as the preferred method for improving communication (p < 0.001). Among dental students, 49% favored QR codes as the best method for postoperative instructions, and 50.5% indicated that QR codes boosted their confidence in providing instructions to patients. Preference for QR codes ranged from 43.5% to 65.5% across different aspects evaluated. Notably, among patients aged 60 years or older, 65.5% considered QR codes the most convenient for the elderly. Mann–Whitney U tests showed statistically significant differences between students and patients for ease of access (p = 0.009, rank biserial r = −0.143), video length appropriateness (p = 0.003, rank biserial r = −0.160), and the unlikelihood of missing instructions (p < 0.001, rank biserial r = −0.446). Conclusions: QR code-based video instructions were widely preferred over traditional methods by both dental students and patients for post-extraction care delivery. These findings support the integration of digital communication tools into post-extraction care protocols as a complement to traditional instruction delivery methods, though longitudinal studies assessing actual clinical outcomes are needed. Full article

Wireless sensor networks supported by mobile edge computing are increasingly required to process heterogeneous sensing data under stringent latency, reliability, and energy constraints. However, most existing task-offloading studies are still formulated for generic user equipment and primarily focus on uplink transmission, which is insufficient for practical sensing systems where sensor nodes continuously upload measurements while simultaneously receiving control commands, model updates, and feedback from the edge. To address this gap, this paper reformulates joint computation offloading and power control as a sensor-aware optimization problem in an edge-assisted wireless sensor network. We propose a three-layer architecture consisting of sensor nodes, access points with lightweight edge servers, and a cloud coordination layer. Each sensing task is characterized by data size, computation density, latency deadline, and sensing priority, while the optimization objective jointly minimizes long-term task delay, communication and computation energy, and packet-loss penalty under transmission power, edge resource, and residual-energy constraints. To solve the resulting mixed discrete–continuous problem, we develop a multi-agent reinforcement learning framework in which each sensor node acts as an autonomous agent and learns offloading and transmission policies with clipped proximal policy optimization, while the cloud layer performs coordinated edge-resource allocation through the alternating direction method of multipliers. In addition to delay and energy, network lifetime and sensing delivery performance are incorporated into the evaluation. Simulation results in a sensor-network monitoring scenario demonstrate that the proposed framework consistently reduces latency, lowers energy consumption, and prolongs network lifetime compared with representative baselines, highlighting its effectiveness and practical potential for intelligent sensing applications that require integrated sensing, communication, and edge computing. Full article

Background: Large language models and other generative artificial intelligence (AI) tools are increasingly being embedded in digital healthcare services, including mobile health applications, telerehabilitation, remote monitoring, and hybrid care pathways. In this review, digital healthcare refers to technology-mediated healthcare services in which digital platforms, mobile applications, wearables, remote communication, and AI-enabled interfaces support health assessment, self-management, rehabilitation, clinical decision support, or service delivery. When AI-generated exercise guidance moves from general education to individualized recommendations about dose, progression, contraindications, or rehabilitation, it may become directly actionable and safety-relevant. Objectives: This review aimed to clarify when AI-generated exercise guidance in digital healthcare may warrant safety-relevant governance attention and to outline implementation considerations for explainability, human oversight, and service-level governance. It addresses a gap in the literature: general AI-governance and exercise-prescription discussions rarely specify how point-of-use explanations, review thresholds, and escalation safeguards can be organized for directly actionable AI exercise guidance. Methods: We conducted a governance-oriented narrative review of peer-reviewed literature and representative regulatory or guidance documents. This review was not designed as a systematic review, scoping review, or exhaustive evidence map; transparent source mapping was used to support conceptual synthesis. Searches and source mapping focused on generative AI, large language models, explainable AI, clinical decision support, digital health, mobile health, exercise prescription, rehabilitation, trust, automation bias, and human oversight. Sources were included when they informed the safety, explainability, governance, or real-world implementation of patient-facing AI-generated exercise guidance. Extracted material was grouped by evidentiary role and synthesized through framework synthesis and governance mapping to distinguish literature-supported observations, author interpretation, and proposed implementation tools. Results: The included sources were first organized into five thematic groups: digital exercise delivery and exercise-prescription evidence; explainability, trust, and automation bias literature; professional responsibility, ethics, and patient disclosure literature; regulatory and policy documents; and digital literacy, patient/clinician attitudes, and equity literature. The synthesis then proceeded from safety relevance to explanation needs, human oversight and escalation needs, and selected regulatory and policy signals before translating these strands into conceptual and implementation-oriented outputs rather than empirically validated instruments. AI-generated exercise guidance was most safety-relevant in scenarios involving individualized dose, progression, contraindication-sensitive action, or rehabilitation strategy. Across the included sources, generic transparency alone was not sufficient to support reviewable use; relevant explanation elements included evidence sources, risk warnings, reasoning paths, and reasonable alternatives. Oversight considerations varied with embodied risk, clinical ambiguity, user vulnerability, and likelihood of direct enactment. Implementation considerations linked interface design, clinical review, escalation, auditability, and post-deployment monitoring. Conclusions: AI-generated exercise guidance in digital healthcare may warrant governance attention as a patient-safety and accountability issue when it influences actionable exercise decisions. The proposed framework offers a conceptual basis for designing more reviewable and accountable mobile and remote exercise-support services. Future work can validate these outputs in patient-facing services, clinician review workflows, usability studies, implementation pilots, and safety evaluations. Full article

Background/Objectives: Advanced technologies in type 1 diabetes mellitus (T1DM) management have reshaped the strategies used to achieve optimal glucose control. Continuous subcutaneous insulin infusion (CSII) and automated insulin delivery (AID) systems are effective alternatives to multiple daily injections (MDI). This study aims to evaluate glycemic regulation in children and adolescents transitioning from MDI to insulin pumps and to raise awareness among patients and their families regarding the benefits of these systems. Methods: 50 pediatric patients with T1DM (24 males, 26 females; mean age 10.76 ± 3.2 years) were evaluated. Cycle 1 established MDI metrics 3 months pre-transition. In cycle 2, patients transitioned either to an AID system (Medtronic MiniMed 780G, (Northridge, CA, USA), 78%), or a non-automated system (Omnipod DASH, 22%). Data were assessed at 3 and 6 months post-initiation. Parameters assessed were glycosylated hemoglobin (HbA1c), time in range (TIR), time above range (TAR), time below range (TBR), glucose management indicator (GMI) and coefficient of variation (CV). Results: The cohort exhibited a statistically significant increase in TIR (p = 0.0038) with mean values of 70.9% at 3 months and 73.2% at 6 months. TAR significantly reduced (p = 0.033) to 26.5% and 24.3% at 3 and 6 months, respectively. Sub-analysis in the AID group revealed a marked increase in TIR (p = 0.0001) alongside significant reductions in TAR (p = 0.0009) and GMI (p = 0.03). Conclusions: Transitioning from MDI to insulin pump therapy, particularly AID systems, leads to modest but significant improvements in specific sensor metrics (TIR, TAR) in real-world clinical practice. The consistency of these results across age groups indicates that AID systems can successfully overcome pediatric and adolescent diabetes management challenges. Full article

Background/Objective: Postpartum hemorrhage is a leading cause of maternal morbidity and mortality, particularly among high-risk women undergoing cesarean section. This systematic review and meta-analysis evaluated the efficacy and safety of prophylactic tranexamic acid in high-risk cesarean sections. Methods: A systematic review and meta-analysis of randomized controlled trials was conducted. Risk of bias was assessed using RoB 2.0 and certainty of evidence was evaluated with GRADE. Random-effects meta-analyses, subgroup analyses and sensitivity analyses were performed. PROSPERO: CRD420251087054. Results: Nine randomized controlled trials involving 1776 participants were included. Tranexamic acid reduced total blood loss (MD −300.78; 95% CI −459.78 to −157.77), with greater efficacy when administered 15–20 min before incision (SMD −0.61; 95% CI −0.82 to −0.39). It also reduced intraoperative blood loss (MD −256.71 mL; 95% CI −375.04 to −138.39), blood loss >1000 mL (RR 0.24; 95% CI 0.14 to 0.41), additional uterotonics (RR 0.37; 95% CI 0.24 to 0.58), blood transfusions (RR 0.30; 95% CI 0.22 to 0.40), and complementary surgical interventions (RR 0.35; 95% CI 0.16 to 0.78). Conclusions: Prophylactic tranexamic acid may reduce blood loss in high-risk cesarean deliveries, particularly when administered 15–20 min before skin incision. It may decrease total and intraoperative blood loss and blood loss exceeding 1000 mL. It also likely reduces the postoperative decline in hemoglobin, the need for additional uterotonics, blood transfusions, and complementary surgical interventions; however, its effect on hematocrit remains uncertain. Full article