Intensive Care National Audit and Research Centre. Female admissions (aged 16-50 years) to adult, general critical care units in England, Wales and Northern Ireland reported as ‘currently pregnant’ or ‘recently pregnant’. 2013. (accessed 14 June 2017)

Kruithof EK, Tran-Thang C, Gudinchet A Fibrinolysis in pregnancy: a study of plasminogen activator inhibitors. Blood. 1987; 69:(2)460-6

Mavrides E, Allard S, Chandraharan E Prevention and management of postpartum haemorrhage. BJOG. 2016; 124

Sawamura A, Hayakawa M, Gando S Disseminated intravascular cooagualtion with fibrinolytic phenotype at an early phase of trauma predicts mortality. Thromb Res. 2009; 124:(5)608-13

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet. 2017; 389:(10084)2105-16

WHO recommendations for the prevention and treatment of postpartum haemorrhage.Geneva: WHO; 2012

The WOMAN trial

02 October 2017
Volume 25 · Issue 10


A study published in The Lancet suggests that tranexamic acid could be significantly reduce maternal deaths from postpartum haemorrhage. Sophie Windsor explores its potential in the UK

Postpartum haemorrhage (PPH) is the leading cause of maternal death worldwide, with approximately 100 000 deaths per year (World Health Organization, 2013). PPH is also a leading cause of maternal morbidity in the UK and the top cause of postnatal admissions to intensive care units (Intensive Care National Audit and Research Centre, 2012).

It is with great interest that I read a study about the effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with PPH (WOMAN Trial collaborators, 2017). Even though this was an international study in low resource settings, I wondered what we could learn for our own practice.

Tranexamic acid is an antifibrinolytic drug that primarily works by inhibiting the breakdown of clots (fibrinolysis). Early activation of fibrinolysis is common after trauma and is associated with increased mortality (Sawamura et al, 2009). Previous studies have found that serum concentrations of tissue plasminogen activator double in the first hour after birth, probably due to tissue damage at birth (Kruithof et al, 1987).

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