postpartum haemorrhage

    Cheap drug found to save lives of mothers after childbirth

    16 May 2017

    A cheap and widely available drug could reduce deaths from severe blood loss after childbirth by as much as 31 per cent, according to a report in the Lancet.

    The drug, called tranexamic acid, works by stopping blood clots from breaking down. The global trial of 20,000 women found it reduced deaths from severe blood loss by a fifth overall and by 31 per cent among women who had received the drug within three hours.

    Postpartum haemorrhage is the leading cause of maternal deaths worldwide. The condition kills more than 100,000 women every year.

    The researchers, from the London School of Hygiene and Tropical Medicine, studied mothers from 21 countries, mostly in Asia and Africa, but also in Britain.

    They found that, of the women suffering from PPH, 89 of those given tranexamic acid within three hours died from bleeding, compared with 127 given a placebo.

    They found no negative side effects associated with the drug in mothers or infants.

    Haleema Shakur, the trial’s lead researcher, said: ‘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. 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.’

    Ian Roberts, the study’s co-leader, said: ‘The researchers who invented tranexamic acid more than 50 years ago hoped it would reduce deaths from postpartum haemorrhage, but they couldn’t persuade obstetricians at the time to conduct a trial.

    ‘Now we finally have these results that we hope can help save women’s lives around the world.’

    Current World Health Organisation guidelines, based on previous research, recommend the use of tranexamic acid in postpartum haemorrhage as a subsequent treatment option if uterotonics (drugs to induce contractions) fail to control the bleeding, or if the bleeding is thought to be due to trauma.

    Instant analysis
    PPH (postpartum haemorrhage) is the number one cause of maternal mortality worldwide, specifically in developing countries as well as in the US. In Britain it is the second most common cause of maternal mortality. It is estimated that a mother dies following delivery-related bleeding every eight minutes worldwide.

    In cases of PPH there is only a small window of opportunity to arrest bleeding before the situation becomes unsalvageable.

    This multi-centre, international, randomised controlled trial looked at the routine administration of a medication called tranexamic acid at the onset of a postpartum haemorrhage. The drug works by preventing breakdown of formed clots, and hence decreases overall blood loss in other settings, eg, in trauma surgery. The study indicated that, if the drug was administered, there was a 19 per cent decrease in the risk of maternal death.

    At first sight, the numbers argue for a change in practice. Nineteen per cent is a significant decrease in mortality, the drug is cheap and available and is associated with minimal side effects.

    We must, however, reconcile the results of an international trial with national experience. This 19 per cent decrease may be sufficient in settings with inferior facilities, training and staff, but Britain is unique among many countries in this regard.

    There is no equivalent to the UK Confidential Enquiry into Maternal Deaths, a triennial report that started in the 1950s which identified all maternal deaths and their causes, but also made recommendations to prevent them that positively affected both training and provision of NHS maternity services. There has subsequently been a decrease in overall maternal mortality from 90 women per 100,000 to 8.5 per 100,000, according to the latest report, and PPH is now the number two cause of maternal deaths related to pregnancy. This is something to celebrate.

    Based on this, there may, in fact, be no need to add tranexamic acid to the routine list of emergency medications to be used at a PPH in Britain, except in select circumstances.
    Research score: 4/5