WHO changes guidance on averting maternal deaths. Here’s how it happened.
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. This was as a result of the reports of the WOMAN trial.
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.
The WOMAN trial results reported in April 2017 involved 20,060 women from 21 countries. In the latest study, published in The Lancet, the investigators combined the results with data from the CRASH-2 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.
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.