An inexpensive and widely available drug given intravenously within three hours of childbirth could save the lives of one in three new mothers who would otherwise bleed to death after delivery, reports a study in The Lancet .
A global WOMAN (World Maternal Antifibrinolytic) Trial of more than 20,000 women from 193 hospitals in 21 countries, including India, found that giving drug called tranexamic acid (TXA) within three hours after childbirth reduced death from bleeding by 31% and lowered the need for emergency surgery to control bleeding (laparotomy) in one in three (36%) cases.
TXA stops bleeding by stopping blood clots from breaking down too quickly. Severe bleeding after childbirth (known as post-partum haemorrhage or PPH) is the leading cause of the 100,000 maternal death worldwide.
TXA injections are manufactured by several pharma companies in India and cost between R 30 and R 50.
The study found 89 women given tranexamic acid died compared with 127 given placebo in addition to standard care. There were no side effects for either mothers or babies. The study builds on previous research involving 20,000 trauma patients, which showed that tranexamic reduced deaths due to bleeding by almost a third if given within three hours.
India’s maternal mortality rate (deaths per every 100,000 live births) is 167, shows data from the Sample Registration System. In 2015, around 45,000 women died from childbirth-related causes, including post-partum haemorrhage -- defined as a blood loss of more than 500ml -- within 24 hours of giving birth.
“We now have important evidence that the early use of tranexamic acid can save women’s lives. 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,” said Haleema Shakur, associate professor of clinical trials at the London School of Hygiene & Tropical Medicine and Project Director on the WOMAN Trial.
The drug, however, did not prevent a new mother’s risk of having her womb surgically removal (hysterectomy). In situations where safe blood supply is limited, a life-saving hysterectomy is sometimes done immediately after severe haemorrhaging starts, which left no time for TXA to have an effect.