Sometimes, the answer to severe hemorrhage turns out to be not a device or gadget, but an innovative surgical technique--in this case the B-Lynch suture.

Over 100,000 women die of postpartum hemorrhage (PPH) each year, accounting for 35% of all maternal deaths. An estimated 90% of these cases are caused when the uterus is unable to adequately contract after childbirth (uterine atony).

Anemia is associated with postpartum hemorrhage-- but why? For the non-clinical elements among us, we seek to break down this issue a little further. 45% of women worldwide are anemic, roughly half of them due to iron-deficiency anemia caused by inadequate iron in the diet. Pregnancy puts a high demand on iron stores, and women who have had multiple pregnancies and perhaps began in a slightly anemic state are further depleted with each pregnancy. Thus a woman facing labor in a moderately or severely anemic state may be at greater risk from excessive blood loss.

Given the importance of postpartum hemorrhage as a cause of death for women worldwide, we are interested in just about any discipline that tackles the issue from a new perspective. Though we've asked a lot of questions about postpartum hemorrhage and its etiology (the medical/scientific reason it happens; [see a former blog post here] (http://maternova.net/blog/what-causes-postpartum-hemorrhage), one question we had certainly never thought to ask was, "do other mammals and primates suffer from postpartum hemorrhage the way we humans do? It's kind of a startling question and two women, evolutionary anthropologists, recently took on. Elizabeth Abrams and Julienne Rutherford, recently had their work published in [The American Anthropologist] (http://www.ncbi.nlm.nih.gov/pubmed/21909154)

We focus on postpartum hemorrhage because it is the leading cause of maternal death in most settings. Obstetric hemorrhage kills an estimated 150,000 women each year, most of whom live in low-resource settings.

While we like to focus on highly practical solutions that improve maternal survival, we are also interested in solutions still in research and development. Artificial or synthetic blood is one such invention that could change everything. There are several reasons why a woman might need a blood transfusion-chief among them severe anemia or blood loss due to postpartum hemorrhage. Right now, a blood transfusion requires a blood banking system, something that is difficult for many lower-level health facilities. What's more, an enormous number of the transfusions in lower-resource settings are not tested for HIV and Hepatitis. Women are brought in on stretchers, in buses and in cars to facilities where it is often impossible to save them because blood is not available. Story after story is told of husbands and family members rushing around looking for a blood donor. How different could it be if stores of synthetic blood were available?

A huge clinical trial is underway to test TXA acid, a drug used in trauma patients, for use in women with postpartum hemorrhage.

The London School of Hygiene and Tropical Medicine (LSHTM), led by chief investigator Professor Ian Roberts, is currently testing the use of “tranexamic (TXA) acid for the treatment of postpartum hemorrhage.” TXA is a “systemic antifribiololytic agent,” meaning it acts to inhibit clot breakdown (fibriololysys), therefore encouraging clotting and decreasing blood loss in incidents of bleeding. Postpartum hemorrhage is a leading cause of obstetric deaths and positive trial results could provide another tool for saving women's lives.

A huge clinical trial is underway to test TXA acid, a drug used in trauma patients, for use in women with postpartum hemorrhage.