Severe bleeding after childbirth or post-partum haemorrhage is the leading cause of maternal deaths around the world. About six per cent of all women who undergo childbirth experience post-partum haemorrhage. This blood loss of more than 500 ml within 24 hours of giving birth occurs among women in better developed and less developed countries. However, death from this kind of severe bleeding occurs much more among women in poor countries.
According to the United Nations, 77% of maternal deaths occur in 20 countries including India, Bangladesh, Pakistan, Nigeria and Ethiopia. India has 45,000 maternal deaths in 2015 and post-partum haemorrhage was the leading cause. Many women in poor countries die of the condition simply because hospitals and medical facilities do not have enough blood at hand to replace the large volumes of blood that these patients lose.
A new drug could now save many of these lives because it is inexpensive, easily available and can be administered by a doctor, nurse or midwife. Researchers at the London School of Hygiene and Tropical Medicine have just concluded a large randomised controlled study to test a whether the drug tranexamic acid can stop post-partum haemorrhage. Tranexamic acid prevents blood clots from breaking down. It has been used in trauma procedures and has been found to save the lives of between 10% and 15% of trauma victims.
The World Maternal Antifibrinolytic or WOMAN trial recruited 20,000 mothers from 193 hospitals in 21 countries, in Africa, Asia and also in developed countries like the United Kingdom. The trial was funded by The Wellcome Trust, the UK Department of Health and the Bill & Melinda Gates Foundation.
The researchers found that the use of tranexamic acid reduced the number of deaths from bleeding after childbirth by a third. Among the women who were given tranexamic acid within three hours of childbirth, 89 died from bleeding compared to 127 deaths among women given a placebo in addition to standard care. There were also no reported side effects from the drug for either mothers or babies. These findings suggest that tranexamic acid could be used as a frontline treatment for women in labour. The study has been published in the journal The Lancet.
Here is the story of how tranexamic acid, which has the potential to save the lives of millions of mothers, was first discovered by a husband and wife team in post-World War II Japan.