Background and rationale {6a}
anaemia, death, bleeding, dizziness, nausea,, PPH, deaths
ANAEMIA, BLEEDING, POSTPARTUM HAEMORRHAGE
Postpartum haemorrhage (PPH) is a leading cause of maternal death, responsible for about 70,000 deaths each year, worldwide [Tranexamic acid is more effective when given early, around the time bleeding starts. Every 15-min delay reduces the survival benefit by about 10% [Before using tranexamic acid to prevent PPH, we need good evidence of the benefits and any potential harms. Only a small proportion of births are complicated by PPH, and even when PPH does occur, most women survive. Assuming the risk of PPH is 5% and that tranexamic acid cuts this risk by 20%, we would need to treat 100 women to prevent one PPH. If there are no important harms, this might be acceptable, but if there are harms, the balance of benefits and harms will need careful consideration.The ongoing WOMAN-2 trial is evaluating the effects of tranexamic acid at cord clamping for the prevention of PPH in women with moderate and severe anaemia having a vaginal birth [The I’M WOMAN trial will evaluate the effects of tranexamic acid just before birth for the prevention of PPH in women with one or more risk factors for PPH giving birth vaginally or by caesarean section (CS). The results will deepen our understanding of the benefits and harms of tranexamic acid for PPH prevention. The trial will also evaluate the effect of the route of tranexamic acid administration. Tranexamic acid is usually given by slow IV injection. However, recent research shows that tranexamic acid is well tolerated and rapidly absorbed after intramuscular (IM) injection, achieving therapeutic blood concentrations within minutes of injection [There may be fewer side effects with IM tranexamic acid. In general, the risk of side effects is increased at high blood concentrations. Although tranexamic acid is rapidly absorbed after IM injection, reaching therapeutic concentrations within minutes, because of the absorption phase, peak blood concentrations are lower than with the IV route. By avoiding high blood concentrations, the IM route might cause fewer side effects (e.g. nausea, vomiting, dizziness). A better safety profile would be particularly important when using tranexamic acid for PPH prevention. The IM route would also have practical advantages. By avoiding the need for IV line insertion and a slow IV injection, it would free up overstretched midwives and doctors to focus on looking after the mother and baby.Giving tranexamic acid before the bleeding becomes serious should maximise the benefits [