A military injection might save tens of thousands of birthing deaths 2023

An injectable designed for military use to prevent combat hemorrhaging might save tens of thousands of women from delivery deaths.

Tranexamic acid (TXA), a medication that stops bleeding, may be safely administered to women during childbirth, according to a stage two clinical trial headed by London School of Hygiene and Tropical Medicine experts.

The medicine has been administered intravenously (IV) until recently, which is impractical in many low-income nations.

At least 70,000 women die from postpartum hemorrhages each year, 25% of all maternal deaths.

Professor Haleema Shakur-Still of the London School of Hygiene and Tropical Medicine said that immediate delivery assistance was crucial and that IV infusions for clotting therapies were not helping.

She added the medicine is only beneficial if administered as soon as possible after bleeding starts and is ineffective beyond three hours.

Midwives identify most postpartum hemorrhages, but they are rarely trained to administer the medicine by IV. Midwives who can give injections will help.

Military reasoning

“We also imagine a situation where you have a pre-filled syringe with the medicine that the police or ambulance can inject in an emergency,” Prof. Shakur-Still said, referencing battlefield use.

The experiment, published Thursday in the British Journal of Obstetrics and Gynaecology, suggests this is possible.

Before bleeding started, 120 Pakistani and Zambian women at risk of postpartum hemorrhage received a TXA injection, pill, or placebo.

The injection and tablet were safe for women and newborns, however the tablet took an hour to work. Injections took 10 minutes, like IV drips.

A 30,000-woman phase three experiment will examine effectiveness. Given prior research, they expect the injections to be utilized worldwide within three years if effective.

TXA stabilizes clots in acute bleeding.

After a successful study, UK paramedics have used an injectable version to treat trauma victims since 2020.

Prof. Shakur-Still said the military was the first to express interest in an injectable version of TXA that soldiers might carry in the field to treat injuries.

“We ran a research that showed trauma sufferers absorbed it well if you gave it [as an injection], and in the UK it is now routine treatment.”

She said postpartum pregnancy might save “tens of thousands” of lives if this is true.

Prof. Rizwana Chaudhri, co-author of the paper from Shifa Tameer-e-Millat University in Pakistan, said the injectable approach will benefit Pakistan.

“Some postpartum hemorrhage patients have trouble getting an intravenous line, so anything that reduces severe bleeding can help. That may be the first and last choice.”

Reversing setbacks

In February, the UN cautioned that maternal mortality has stagnated after decades of decline (from 446,000 in 2020 to roughly 290,000 in 2020).

Most occurrences are avoidable and occur in sub-Saharan Africa and south Asia. Severe bleeding, infections, delivery problems, high blood pressure, and unsafe abortions kill.

“For millions of families, the miracle of delivery is overshadowed by the sorrow of maternal deaths,” said Catherine Russell, Unicef’s executive director.

“No mother should worry about her life while giving birth, especially when the knowledge and means to handle common difficulties exist.”

Prof. Shakur-Still said further work is needed to make TXA, which decreases the danger of a woman bleeding to death by 30% if administered within three hours, available worldwide.

“We really have to work at it, because not only will it save young men from road traffic crashes and deaths, from all kinds of stress, but it will save young mothers,” she added.

Due to middlemen and distributors, therapy in Nigeria costs more than £1 in the UK. It’s a generic medicine and cheap to give, so this shouldn’t happen.”

Prof. Shakur-Still stated that diagnosing and treating anemia is the “single largest” strategy to prevent birthing deaths.

“Anaemia is really widespread throughout over sub-Saharan Africa and southeast Asia, and a lot of the time when a woman arrives to give birth she’s so weakened by anaemia that an infection or bleeding… may have a really harmful impact,” she added. “So making TXA broadly available is vital, but it’s not the sole action needed to save lives.”