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Recent research underscores the use of a drug that helps the blood clot in women who suffer post-partum hemorrhage.

Tranexamic acid (TXA) is an antifibrinolytic drug, that is, a drug that helps blood clot during episodes of bleeding.  During and after childbirth, episodes of bleeding called post-partum hemorrhage (PPH) can occur which are dangerous—and sometimes deadly to mom.

The Centers for Disease Control and Prevention (CDC) list hemorrhage as a leading cause of pregnancy-related death. With the proper care, the CDC notes many of the leading drivers of maternal morbidity are preventable.  While PPH is not often preventable—mom’s life can be saved with quick and effective treatment. Commenting on PPH, Dr. Peter Cherouny remarked, “In severe cases, women can lose their blood volume in six to ten minutes.”

Following the birth of a child and delivery of the placenta, the uterus continues to contract to reduce bleeding in the region of the uterus where the placenta was attached. Blood loss of approximately half a quart is common during vaginal childbirth.  During a c-section, women lose approximately a quart of blood.  Anything over those quantities is considered significant and requires treatment. 

Vasculature attached to the placenta relies on those contractions to stop the flow of blood after the placenta separates from the uterine wall and is delivered.  Uterine atony is a condition where the squeezing of uterine muscles is not adequate to inhibit bleeding where the placenta separated from the muscle wall.  As a result, a mother can lose significant quantities of blood. While PPH is more likely to occur at birth, PPH usually occurs within a day, but sometimes up to 12 weeks of delivery.  Worldwide, PPH causes the death of approximately 100,000 women each year.

Similarly dangerous are hospitals that do not evaluate blood loss in recuperating mothers. While nurses can guess how much blood is lost post-partum, these estimates are often inaccurate and can lead to women suffering shock from blood loss and death.

A recent study published in the BJOG  evaluated delivery methods of TXA and their use in women suffering PPH.  The study draws on data from the WOMAN-Pharmaco TXA study, which collected data from 21 countries to evaluate oral, IV, and intramuscular delivery. The study found all three delivery forms effective, with a significant delay in the blood concentration with oral use. Future research will focus on whether IV or intramuscular treatment is more effective.

For now, the finding that intramuscular treatment is safe and effective provides an important treatment option for women in childbirth emergency or in rural settings without immediate IV access.  Recognizing and being prepared to treat PPH is critical to reducing maternal morbidity in the US, and around the world.

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