The WOMAN trial

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).