post-partum haemorrhage (pPH)

Every year about 14 million women around the world suffer from postpartum haemorrhage (PPH) after giving birth and about 100,000 of them will die


Imagine, about every six minutes, a woman giving birth will bleed to death

 

 

Finding better ways to save the lives of women suffering PPH is critical 

Research Overview

Tranexamic Acid (TXA) for PPH

The WOMAN Trial evaluated the effect of TXA on death, hysterectomy and other surgical interventions, and thromboembolic events in women with clinically diagnosed PPH.

A total of 20,060 women from 21 countries and 193 sites with PPH were randomly allocated to receive TXA (1g intravenously) or matching placebo in addition to usual care. If bleeding continued, a second dose of 1g was given.

Death due to bleeding was significantly reduced with TXA (relative risk = 0·81, 95% CI0·65–1·00, p = 0·045), particularly in women treated within 3 hours of giving birth (relative risk = 0·69, 95% CI 0·52–0·91, p=0·008).

The WOMAN trial showed that if given within 3 hours, TXA can reduce the risk of death due to bleeding by one-third and the need for surgery to stop bleeding by over one-third.

However, for many women, the treatment of PPH is too late to prevent death. Over one-third of pregnant women in the world are anaemic and many are severely anaemic. These women have an increased risk of PPH and suffer more severe outcomes if PPH occurs.

There is an urgent need to identify a safe and effective way to reduce postpartum bleeding in anaemic women. The WOMAN-2 trial investigates if we can use TXA to prevent PPH from happening in the first place.

More Resources

Click on watch, read or teach to access videos, publications, and training materials 

WOMAN Trial: Her Life Matters Trailer 1

Most women with PPH are not benefiting from TXA. Join the campaign. A documentary detailing successes and failures will be available here.

WOMAN Trial: Her Life Matters Trailer 2

 

WOMAN Trial: Results Video

WOMAN Trial: BBC News Africa

Interview discussion on the WOMAN Trial results
Watch here

WOMAN Trial: TXA for the Treatment of PPH

WOMAN Trial: Can we prevent women dying after childbirth?

 

WOMAN Trial: ‘The Blood Clock’ Art Installation 

WOMAN Trial Procedure

WOMAN Trial: Teaser 1

WOMAN Trial: Teaser 2

WOMAN Trial: Teaser 3

WOMAN Trial: Nigeria

Nigerian doctors, midwives, patients and families share their experience of postpartum haemorrhage (PPH) and explain the heavy burden it weighs on the Nigerian population and health system.

 

WOMAN: Trial Results

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WOMAN TRIAL TRANEXAMIC ACID RESEARCH TXA CLINICAL TRIAL PPH MATERNAL WOMEN HEALTH

WOMAN: Effect of treatment delay: a meta-analysis of 40,138  patients 

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Impact of TXA treatment delay for severe bleeding TXA clinical trial research tranexamic acid saves lives

 

WOMAN: World Health Organisation (WHO) recommendation on TXA for the treatment of PPH

Key recommendation: Administration of TXA should be considered as part of the first line PPH treatment and be administered as soon as possible after the onset of bleeding and within 3 hours of birth

Summary Recommended Guidelines
Full Recommended Guidelines

 

WOMAN: What, who and when

Tranexamic acid for post-partum haemorrhage
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WOMAN: Art for Maternal Health Awareness

Sculpture artist, Moira Purver was commissioned by the WOMAN trial to create this spectacular bronze statue, appropriately titled WOMAN, that depicts a mother on her knees holding her new baby in her arms just after giving birth.
Learn more

 

WOMAN: BMC Pregnancy & Childbirth – Research Article

Anti-fibrinolytic agents in postpartum haemorrhage: a systematic review
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WOMAN: Systematic Review

Does tranexamic acid prevent postpartum haemorrhage? A systematic review of randomised controlled trials
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WOMAN: Anti-fibrinolytic Trials Collaboration

Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: a meta-analysis of individual patient-level data from 40 138 bleeding patients
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WOMAN: Clinical and contextual factors on LMIC’s PPH deaths

Clinical and contextual factors surrounding the deaths of 483 women following post-partum haemorrhage in developing countries
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WOMAN: Analysis of the CRASH-2 and WOMAN trials

Risk factors for blood transfusion in traumatic and postpartum hemorrhage patient
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WOMAN: Exploratory Subgroup Analysis

The impact of early outcome events on the effect of tranexamic acid in post-partum haemorrhage: an exploratory subgroup analysis of the WOMAN trial
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WOMAN: Nigeria

Haematological and fibrinolytic status of Nigerian women with post-partum haemorrhage
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WOMAN: Peripartum Hysterectomy Risk

Risk factors for peripartum hysterectomy among women with postpartum haemorrhage: analysis of data from the WOMAN trial
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WOMAN: A Global Issue

Post-partum haemorrhage and tranexamic acid: a global issue
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WOMAN: Finding Better Ways to Prevent Postpartum Hemorrhage

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WOMAN: WOMAN-ETAC Trial

Effect of tranexamic acid on coagulation and fibrinolysis in women with postpartum haemorrhage (WOMAN-ETAC): a single-centre, randomised, double-blind, placebo-controlled trial
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WOMAN: ETAPlaT trial sub-study

Effects of tranexamic acid on platelet function and thrombin generation (ETAPlaT): WOMAN trial sub-study
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WOMAN Trial: Results Presentation

The WOMAN trial showed that TXA can reduce the number of women bleeding to death after childbirth by more than 30%
View PDF

 

WOMAN Trial: Protocol

Study protocol The WOMAN Trial (World Maternal Antifibrinolytic Trial): tranexamic acid for the treatment of postpartum haemorrhage: an international randomised, double-blind placebo-controlled trial
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WOMAN Trial: Statistical Analysis Plan

The effect of tranexamic acid on the risk of death and hysterectomy in women with post-partum haemorrhage: statistical analysis plan for the WOMAN trial
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More Treatments

TXAcentral is a resource for health professionals caring for people with acute bleeding
TXAcentral brings together randomised trial evidence on the effectiveness and safety of tranexamic acid
Data on many of the trials are also available at the freeBIRD website

In trauma patients with significant bleeding and those with traumatic brain injury (TBI), TXA has been  shown to reduce mortality in both extracranial and intracranial bleeding

Postpartum Haemorrhage (PPH) is the leading cause of maternal death worldwide, responsible for around 100 000 deaths each year. TXA given as quickly as possible after birth and no later than 3 hours, reduces death due to bleeding and the need for surgery to stop bleeding

GI Bleeding is a common emergency that causes substantial mortality and morbidity worldwide. TXA was found to not reduce deaths from GI bleeding and showed an increased risk of thromboembolic events

Every year there are over 300 million surgical procedures worldwide. Bleeding is an important complication and many patients require a blood transfusion. TXA reduces blood loss in surgical patients by about one‐third. However, the effects of TXA on thromboembolic events and mortality in surgery are uncertain

There is ongoing research looking at how Tranexamic Acid (TXA) could be utilised for other bleeding conditions