A large international trial has showed that a cheap, readily available drug could save the lives of thousands of women each year who suffer from excessive bleeding after giving birth.
Even though childbirth is safer than ever, post-partum haemorrhage is still a major killer of new mums around the world, accounting for more than 100,000 deaths every year. But now the results are in on a drug that could help solve the problem.
A major study of 20,000 women in 21 countries has shown that a simple intravenous injection of tranexamic acid can prevent a third of the deaths caused by post-partum bleeding.
Tranexamic acid, which essentially helps blood clot more quickly, is not a new medicine. It was discovered by Japanese doctor Utako Okamoto back in the 1960s, when she was looking for something that could treat devastating bleeding after childbirth.
But at that time, she couldn't persuade any obstetricians to do a trial.
Now it is one of the medications available for women with heavy periods, and is used in different types of surgery to prevent excessive blood loss.
Large-scale trials have already shown that injections of tranexamic acid can prevent deaths from bleeding after accidents, and in 2009, the World Health Organisation (WHO) even added it to the list of essential medicines.
But until this latest trial, we still didn't have solid evidence on whether the drug would indeed be helpful for post-partum bleeding.
To test this hypothesis, in 2010 a research team led by scientists from the London School of Hygiene & Tropical Medicine embarked on a massive trial spanning six years and 21 countries on four continents.
Researchers randomly assigned women with clinically diagnosed post-birth bleeding to either receive a placebo or a tranexamic acid injection in addition to all the usual medical care their cases required.
The study was properly blinded - neither the patients nor the doctors administering the injection knew whether it contained the drug.
The researchers found that if tranexamic acid was injected within three hours after giving birth, it reduced deaths from post-birth bleeding by nearly one-third.
It also appears that it doesn't matter what the cause of the bleeding is, or even what type of birth the woman had - tranexamic acid is still effective, as long as it's given quickly.
These are some amazing results. If every woman who suffers life-threatening bleeding could receive this drug, it could save tens of thousands of lives every year.
Scientists are now looking at new ways to make the drug easy to administer. It's even possible that for women who are at higher risk, a tablet could be given before birth.
This is especially relevant in many African countries, where women often don't get timely treatment for pregnancy-related anemia.
"Half the women giving birth there start off with roughly half the red blood cells they should have," one of the researchers, Ian Roberts, told Donald G. McNeil at The New York Times.
"Doctors are forced to throw in everything they've got, because they know the woman can be dead in an hour."
Currently, the WHO guidelines for the treatment of post-partum haemorrhage recommend injecting drugs that contract the uterus, such as oxytocin, in addition to massaging the uterus. The guidelines do mention tranexamic acid, but it's not a first-line treatment.
Now that we know its life-saving potential, those guidelines are ready for an update.
"Our results support the inclusion of tranexamic acid in WHO treatment guidelines for primary post-partum haemorrhage," the researchers write.
Tranexamic acid is available as a generic medication, and an injection can cost less than a dollar.
But researchers emphasise that in many low-income and middle-income countries, women die of post-partum bleeding at home, where nobody can quickly give them an intravenous injection.
Many of the patients in the trial whose deaths could not be prevented arrived at the hospital too late.
"We have to make sure tranexamic acid is available wherever a woman gives birth and is at risk," lead researcher Haleema Shakur told Sarah Boseley at The Guardian.
"We must make sure doctors and midwives are aware of the results of the study. And we need health ministers to make sure that the drug is available in their country and is on their shopping list of essential medicines."
The trial was published in The Lancet.