WHO changes guidance on averting maternal deaths after WOMAN trial results

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.

Doctor holding a baby.
Immediate treatment with tranexamic acid will stop many women with severe bleeding from dying after childbirth.
Credit: London School of Hygiene & Tropical Medicine

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, which was coordinated by the London School of Hygiene & Tropical Medicine, 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, 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.

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.

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