Commonly used drug may be key to stopping thousands of mothers dying

A mother and child
A mother carrying her child used to illustrate the story

Roughly every six minutes, a woman somewhere in the world bleeds to death in child birth. But a new medical trial shows that there is a way of combating the problem.

The trial has found that a simple drug called tranexamic acid, a blood clot stabiliser first discovered in Japan in the 1950s, could cut deaths from bleeding by a third if given to women within three hours.

In London this week, experts on the issue of what the medical community calls “post-partum haemorrhage” (PPH) met to highlight the trial’s findings and to discuss how to promote the use of the drug.

The event took place at the London School of Hygiene & Tropical Medicine, which hosts the collaboration known as the WOMAN Trial.

PPH is the leading cause of maternal death globally. It kills about 100,000 women, mostly in low and middle income countries.

Philanthropist Toyin Saraki, the founding president of the Wellbeing Foundation Africa and an ambassador for the International Confederation of Midwives, told the meeting that the risk of death in childbirth remains “painstakingly high” in sub-Saharan Africa.

“In Nigeria, for example, the country of my birth, a woman incurs a one in 23 risk of dying during childbirth in her lifetime,” she said.

“In Chad, with the highest maternal mortality ratios in the world, this figure is closer to one in 17. It is countries such as these that can benefit the most from tranexamic acid.”

Saraki said the use of a “cheap and effective” drug such as tranexamic acid could constitute “a significant step closer to fair and equal maternal care around the world…

“If administered across Africa, the health outcomes would be immense and would lead to lives of thousands of women across Africa being saved.”
But, she added, this will not be easily achieved.

The Trial Explained (Press Release)

The WOMAN trial, coordinated by the London School of Hygiene & Tropical Medicine (LSHTM) Clinical Trials Unit (CTU) is an international clinical trial of the effect of tranexamic acid on death, hysterectomy and other maternal outcomes, in women with PPH.

The trial tested whether tranexamic acid, a blood clot stabiliser that was discovered in Japan in the 1950’s, could become an essential tool for fighting excessive bleeding soon after giving birth. This condition, known as postpartum haemorrhage, is the number one cause of maternal death around the world, particularly in low and middle income countries.

The premise for the WOMAN trial came from the results of the 2010 CRASH2 trial, which showed that tranexamic acid reduces death due to bleeding after serious injury with no apparent increase in thrombotic events.

The CRASH-2 trial enrolled 20,211 bleeding trauma patients from hospitals in 40 countries and showed that tranexamic acid reduces death due to bleeding with no apparent increase in thrombotic events.10 Given soon after injury, tranexamic acid reduces bleeding deaths by a third.11 tranexamic acid is easy to use, heat stable and highly cost-effective.12

There have been a number of small trials of tranexamic acid in obstetric bleeding, most of which show a decrease in blood loss but the quality of the trials is poor and none are large enough to assess the effect of tranexamic acid on maternal outcomes.13 As pregnant women have a heightened risk for thrombosis compared with the general population it is important to assess the efficacy and associated risks of tranexamic acid in this group in this group.

The trial started recruitment in March 2010 and was a global collaboration of obstetricians, midwives, pharmacists, administrators, ethics committees and regulatory agencies that has led to the recruitment of hundreds of women with PPH each month from hospitals worldwide. The trial completed recruited in April 2016, recruiting a total of 20,060 women, from 193 hospital in 21 countries.

The trial findings show that if used within 3 hours, tranexamic acid reduced death due to bleeding by about a third. This means the lives of about one in three mothers who would otherwise bleed to death after childbirth could be saved. The trial findings also show that tranexamic acid reduced the need for urgent surgery to control bleeding (laparotomy) by more than a third and the trial found no increase in complications from the drug for either mothers or babies.

For the full trial results, please visit our results page and use and share the content to raise awareness of the findings.

This post was first published by We have their permission to republish here.

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