An inexpensive and widely available drug could save the lives of one in three mothers who would otherwise bleed to death after childbirth, according to this new major study.

The drug, called tranexamic acid (TXA), works by stopping blood clots from breaking down. The global trial of 20,000 women 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 by more than 36%.

The WOMAN (World Maternal Antifibrinolytic) Trial recruited mothers from 193 hospitals in 21 countries, mainly in Africa and Asia, but also in the UK and elsewhere. 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.

Haleema Shakur, Associate Professor of Clinical Trials at the London School of Hygiene said: "We now have important evidence that the early use of tranexamic acid can save women's lives and ensure more children grow up with a mother. 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."

Tranexamic acid was invented in the 1960s by a Japanese husband and wife research team, Shosuke and Utako Okamoto.

Ian Roberts, who co-led the study, said: "The researchers who invented tranexamic acid more than 50 years ago hoped it would reduce deaths from post-partum haemorrhage, but they couldn't persuade obstetricians at the time to conduct a trial. Now we finally have these results that we hope can help save women's lives around the world."

Almost all of the deaths from post-partum haemorrhage are in low- and middle-income countries. Although giving birth in a health facility increases the chance of surviving post-partum haemorrhage, women still die from the condition even within hospitals.

Tim Knott, Senior Partner in Innovations at Wellcome Trust, said: "Globally, severe bleeding in childbirth remains one of the main causes of maternal death – with alarming numbers of women dying in many low- and middle-income countries. The WOMAN Trial team undertook a hugely important and incredibly ambitious study. Their work stands to make a critical difference in preventing women dying after childbirth."

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(Source: London School of Hygiene and Tropical Medicine)

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