Inexpensive Drug Could Prevent Post-Partum Hemorrhage Deaths

Tranexamic acid reduced post-partum hemorrhage-related deaths by 31%.

Regardless of advances in medicine, some women die as a result of a substantial amount of blood loss during child birth. An inexpensive and easily accessible drug may be able to save new mothers who experienced major blood loss after childbirth, according to a new study published by The Lancet.

The authors found that when the drug, tranexamic acid (TXA), was taken within 3 hours of blood loss, it reduced death from bleeding by 31%. TXA was also found to reduce the need for surgery to reduce bleeding by 36%.

Post-partum hemorrhage is the leading cause of maternal death around the world, with more than 100,000 patients dying each year. It is defined as blood loss of more than 500ml within 24 hours of delivery. The administration of TXA may present a beneficial treatment for this population since the drug stops blood clots from breaking down, according to the study.

Included in the WOMAN Trial were more than 20,000 women. The authors discovered that when given TXA within 3 hours, only 89 patients died from bleeding compared with 127 patients receiving placebo and standard care, according to the study. Importantly, there were no observed side effects for the mother or child.

These findings suggest that TXA may be a first-line treatment for post-partum hemorrhage.

"We now have important evidence that the early use of tranexamic acid can save women's lives and ensure more children grow up with a mother,” said Haleema Shakur, project director of the study. “It's safe, affordable and easy to administer, and we hope that doctors will use it as early as possible following the onset of severe bleeding after childbirth."

TXA was first created in the 1960s and has been used to treat severe bleeding in patients.

"The researchers who invented tranexamic acid more than 50 years ago hoped it would reduce deaths from post-partum haemorrhage [sic], but they couldn't persuade obstetricians at the time to conduct a trial,” said study co-leader Ian Roberts, MB BCh FRCP FPH. “Now we finally have these results that we hope can help save women's lives around the world."

A majority of post-partum hemorrhage cases occur in low- and middle-income countries where adequate resources can be scarce. While giving birth in a healthcare facility increases the likelihood of surviving, patients still die from bleeding.

Although the authors discovered that TXA significantly reduced bleeding among these patients, it was not observed to prevent hysterectomy. In low- and middle-income countries, physicians may perform a hysterectomy to save the mother’s life since the blood supply is typically limited, according to the study. In these situations, TXA does not have a chance to work.

The WOMAN Trial builds on a previous study of 20,000 trauma patients where TXA that was administered within 3 hours was found to reduce deaths by one-third.

Currently, the World Health Organization recommends TXA for patients with post-partum hemorrhage if uterotonics fail to control bleeding or if the bleeding is trauma related. These new findings suggest that TXA may be an adequate first-line treatment, according to the study.

"Globally, severe bleeding in childbirth remains one of the main causes of maternal death -- with alarming numbers of women dying in many low- and middle-income countries,” said Tim Knott, senior partner in Innovations at Wellcome Trust. “The WOMAN Trial team undertook a hugely important and incredibly ambitious study. Their work stands to make a critical difference in preventing women dying after childbirth."