Rawalpindi
A huge percentage of young mothers in Pakistan are dying from heavy bleeding after childbirth known as post-partum haemorrhage, a leading cause of maternal death around the globe that can be prevented and to save thousands of lives of new mothers in the country, it is need of the time to learn from the WOMAN Trial and act on its results which are very encouraging.
Head of Gynaecology and Obstetrics Department at Holy Family Hospital Professor Rizwana Chaudhri expressed this while referring to a global trial of a drug called tranexamic acid (TXA), an inexpensive and widely available drug that according to a major study can save the lives of one in three mothers who would otherwise bleed to death after childbirth.
More than 5,000 women from 47 hospitals in Pakistan took part in the global trial, which included 20,000 women in 21 countries, mainly in Africa and Asia, and also in the UK and elsewhere, reveals the study published in The Lancet.
The drug, tranexamic acid (TXA), works by stopping blood clots from breaking down. The study found that death due to bleeding was reduced by 31% if the treatment was given within three hours. The findings also show it reduced the need for urgent surgery to control bleeding (laparotomy) by more than a third (36%).
Severe bleeding after childbirth claims lives of more than 100,000 women globally each year but this clot-stabilising drug has the potential to reduce the number substantially.
According to the World Health Organization and partners, Pakistan has a maternal mortality rate of 178 deaths per every 100,000 live births. In 2015 there were an estimated 9,700 maternal deaths in the country, and post-partum haemorrhage was the single biggest cause.
The London School of Hygiene & Tropical Medicine coordinated the new study, which is called The WOMAN (World Maternal Antifibrinolytic) Trial. It was funded by The Wellcome Trust and UK Department of Health through the Health Innovation Challenge Fund, and the Bill & Melinda Gates Foundation.
Professor Rizwana Chaudhri, Pakistan Trial Coordinator said, “If tranexamic acid is given quickly enough we could see a reduction in the number of tragic deaths of young mothers and I would urge our hospitals, doctors and community health centres to start administering it as soon as possible, and for us to work together to tackle this issue.”
She added that doctors are facing a number of challenges in Pakistan as the majority of babies are delivered in women’s homes in rural areas with no trained medical staff or facilities available. “This is particularly important when it comes to post-partum haemorrhage because time is such a crucial factor in treating it and saving lives or preventing hysterectomy.”
She said the results show that of the women given tranexamic acid within three hours, 89 died from bleeding compared with 127 given placebo (in addition to standard care). The researchers found no side effects from the drug for either mothers or babies. These findings provide the first comprehensive evidence on using tranexamic acid for post-partum haemorrhage and suggest it should be used as a frontline treatment, said Professor Rizwana.
Tranexamic acid was invented in the 1960s by a Japanese husband and wife research team, Shosuke and Utako Okamoto.
It is important to mention that almost all of the deaths from postpartum haemorrhage are in low-and middle-income countries. Although giving birth in a healthcare facility increases the chance of surviving post-partum haemorrhage, women still die from the condition even within hospitals.
While the WOMAN Trial found that tranexamic acid significantly reduced death due to bleeding, it did not prevent hysterectomy, reveals the study. The researchers say this is because in low-and middle-income countries where blood supplies are limited, a hysterectomy is sometimes carried out immediately after the onset of very severe postpartum haemorrhage to save the mother’s life. This means there is no time for tranexamic acid to have an effect.
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.
Current World Health Organisation guidelines, based on the previous trauma research, recommend the use of tranexamic acid in post-partum 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.
Post-partum haemorrhage is defined as a blood loss of more than 500ml within 24 hours of giving birth, explained Professor Rizwana.
