The randomized controlled trial of the effect of tranexamic acid (TXA) on blood loss during and after cesarean delivery reported by Movafegh et al. [1] in this issue of IJGO is clinically important for two reasons. First, because hemorrhage is a serious complication of cesarean delivery and their data show that bleeding can be reduced by TXA administration; and second, because it raises the possibility that TXA could contribute importantly to reducing the unacceptable high maternal mortality from postpartum hemorrhage. However, the trial by Movafegh et al. [1] cannot be considered in isolation. Four other trials of TXA used at cesarean delivery have been published to date [2–5]. When blood loss data from Movafegh et al. are pooled with data from previous trials, it is clear that there is strong evidence that TXA reduces blood loss during and after cesarean delivery (Fig. 1). But is this important? At this stage, we cannot be completely sure because the trials to date have not been large enough to assess the effect of TXA on outcomes that matter to women. However, there is every reason to expect that a reduction in bleeding would reduce maternal morbidity. Severe anemia following postpartum bleeding is an important cause of maternal morbidity and is likely to makemore women vulnerable to fatal postpartum hemorrhage (PPH) in future pregnancies. Reducing operative blood loss would also reduce the risks and costs associated with blood transfusion. Blood is a scarce resource but even when blood is available, it can transmit potentially fatal viral infections. Economic evaluation has shown that giving TXA to reduce bleeding in elective surgery would be lifesaving in Sub-Saharan Africa where there is a shortage of blood, because more blood will be available for thosewhoneed it [6]. In those countrieswhere blood is readily available,