TXA was developed for the battlefield in Afghanistan. Like so many war-inspired innovations, TXA has implications for maternal health and the battle against postpartum hemorrhage.
Postpartum hemorrhage (PPH) continues to be a leading contributor to maternal mortality worldwide despite various efforts and interventions to prevent and control it. There are methods that have strong evidence supporting its effectiveness but can still benefit from improvements. One of these strategies is the use of a uterine balloon tamponade (UBT), which is recommended by the WHO, International Federation of Gynecology and Obstetrics, and the Royal College of Obstetricians and Gynecologists. The current success rate of the intervention is 60-80%, with the unsuccessful cases requiring further invasive procedures.
Tranexamic acid (TXA) reduces bleeding by restraining the breakdown of fibrin blood clots and is traditionally injected (Martin et al., 2015). A recent systematic review of 26 randomized controlled trials (Ker et al., 2016) suggests that TXA is an inexpensive, widely available medicine that can reduce blood transfusions in surgery and decrease postpartum blood loss. However, many of these trials contained data of questionable quality and reliability.
More recently, in cases of severe PPH, doctors have shown that using a combination of UBT with topical administration of TXAcan be effective treating excessive hemorrhage. This modified UBT method involves an intrauterine balloon catheter with the balloon portion wrapped in gauze soaked with 20 mL of 5% TXA solution. The balloon is then inserted through the cervix into the uterus and inflated with 210 mL of sterile water until it adequately compresses the inner uterus and the TXA-soaked gauze can adhere tightly to the bleeding spots. In addition, a one-meter long piece of normal gauze is packed in the vagina to keep the balloon in place. A blood transfusion was performed at the same time, in addition to intravenous injections of oxytocin, crystalloid fluid, and antibiotics. Bleeding lessened immediately and stopped completely by the next day and the balloon and gauze were removed 20 hours after insertion. She was discharged in good condition with her newborn 5 days postpartum. Another case treated the same way saw the woman discharged in stable condition 4 days postpartum after receiving 10 hours of the treatment.
While the two above cases are encouraging, further randomized controlled trials need to be done to confirm the safety and effectiveness of the UBT + topical TXA procedure.
Blog by Vivian Shih.
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