Postpartum haemorrhage (PPH) is the leading cause of maternal death. Primary causes are mostly of obstetrical origin. PPH can be worsened by secondary coagulopathy. This is due to dilution or consumption of coagulation factors and fibrinolysis activation. The use of tranexamic acid, an antifibrinolytic agent, in the management of PPH has been proposed and practiced for several years, following evidence of its efficacy and safety in other settings, including traumatology. The benefit of administration of TXA during PPH has recently been proved by the WOMAN study. This review recalls the physiopathological mechanisms involved in the genesis and aggravation of PPH. It presents the current state of knowledge on the prophylactic and therapeutic efficacy of tranexamic acid in PPH and summarizes the current recommendations in obstetrics.