In keeping
with our mission to bring current best practice information to colleagues so
that we can be at par with colleagues elsewhere, we share this important change
in a WHO recommendation on controlling maternal death from PPH: READ ON
'WHO changes
guidance on averting maternal deaths after WOMAN trial results
News / Published:
8 November 2017
The WHO has
published new guidance strongly recommending that intravenous tranexamic acid
(TXA) is given to women diagnosed with severe bleeding within three hours of
them giving birth.
Bethan
Hughes, from our Innovations team, explains how the WOMAN trial, which was
co-funded by Wellcome, has prompted the new WHO guidelines.
Earlier this
year, a global trial funded by Wellcome showed that tranexamic acid (TXA) can
prevent almost one in three maternal deaths caused by severe bleeding if given
within three hours of birth.
The latest
study from the WOMAN trial team shows that even more lives could be saved by
giving the drug immediately after severe bleeding is diagnosed.
The
evidence, the researchers say, is clear – TXA should be used worldwide as a
frontline treatment to help reduce the global burden of deaths from severe
bleeding, also known as post-partum haemorrhage.
Each year,
more than 100,000 women die from severe bleeding after childbirth. It is the
leading global cause of maternal death, and most deaths occur in low and
middle-income countries.
Every minute
counts when using TXA to prevent maternal deaths
The WOMAN
trial results reported in April 2017 involved 20,060
women from 21 countries.
In the
latest study, published in The Lancet(opens in a new tab), the investigators
combined the results with data from the CRASH-2(opens in a new
tab) trial of trauma patients.
The analysis
of these 40,138 patients shows immediate treatment with TXA improves survival
after severe postpartum haemorrhage by 70%.
But this
benefit decreases by 10% with every 15-minute delay up to three hours, after
which there is no health benefit.
The new WHO
guidance on using TXA to treat severe bleeding
Previous WHO
guidelines, in 2012, recommended only using TXA in women diagnosed with severe
bleeding when other treatments fail. This guidance was set before the
WOMAN trial results were known.
The new WHO
guidance strongly recommends early use of TXA within three hours of birth as
part of standard care when postpartum haemorrhage is diagnosed.
It also
highlights the need for all health systems, regardless of resourcing, to recognise
that TXA is a life-saving intervention that should be made readily available
wherever emergency obstetric care is provided.
Innovation
can mean looking for new potential in old discoveries
TXA, which
was discovered in the 1960s, costs about £2 a dose and is readily available.
While
science and technology move ever faster, offering incredible opportunities to
improve human health, sometimes innovations to improve global health can mean
looking at the new potential in old discoveries. This research is a great
example of this.
Without the
determination of the WOMAN trial team – and a willingness from
philanthropic funders to support their research – we would not have
the evidence to show that this drug can stop many women from dying after
childbirth.
Wellcome’s
Innovations team is now exploring how we can continue to work with the WOMAN
trial researchers to achieve the greatest impact with this intervention.
The WOMAN
trial was funded by Wellcome and the UK Department of Health, with additional
funding provided by the Bill & Melinda Gates Foundation.’’
Joseph Ana.
Lead Senior
Fellow
Africa Center for Clin Gov Research &
Patient Safety
@ HRI West Africa
Group - HRI WA
Consultants in
Clinical Governance Implementation
Publisher: Health and
Medical Journals
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