Wonder WHY best drug to control childbirth related bleeding has been disgraced 😕😞

"A little knowledge is a dangerous thing, but a little want of knowledge is also a dangerous thing."

- Samuel Butler (1835-1902), an iconoclastic English novelist and writer

Wondering and pondering to learn from childbirth experts to wipe out my IGNORANCE about bleeding management during childbirth.

With my little understanding I am very much curious in my mind to learn about fact, truth and reality wondering and pondering to understand WHY Oxytocin is much more preferred than Tranxemic acid to control and prevent bleeding during childbirth.

We all know that Oxytocin that we administer intravenously via infusion or intramuscular is the best drug of choice to prevent haemorrhage of childbirth. However, it has to keep in a refrigerator to prevent from damage from the heat.

In low income countries like Nepal in rural and remote settings where majority of women face life threatening condition due to bleeding relating childbirth there is no provision to keep Oxytocin in a refrigerator especially in low land/tarai region where heat during summer goes up to 30-40 degree Celsius.

I wonder and ponder WHY we fail to use and recommend very easily affordable, accessible and feasible to keep drug like Tranexamic acid we do prefer instead of Oxytocin to prevent any form of bleeding relating to childbirth although it is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system to prevent any form of bleeding [1].

Tranexamic acid was discovered in 1962 by Utako Okamoto, a Japanese medical doctor working as a medical scientist in her quest to find a drug that would treat bleeding after childbirth (post-partum haemorrhage). She found it was 27 times as powerful and thus a promising hemostatic agent and published their findings in the Keio Journal of Medicine in 1962.

Tranexamic acid's value remained unappreciated for years, and it was not until 2009, that it was included on the WHO list of essential medicines to be used during cardiac surgery.

In 2010, a large randomised controlled trial in trauma patients showed its remarkable benefit if given within 3 hours of injury. Also in 2010, the WOMAN (World Maternal Antifibrinolytic) trial began, a randomised, double-blind, placebo-controlled study of tranexamic acid in 20 060 women with post-partum haemorrhage (Lancet 2016). Enrollment was completed in 2016, and in April 2017, the results were published and showed that tranexamic acid reduced death in the 10,036 treated women versus the 9985 on placebo with no adverse effects (Lancet 2017).

Professor Sir Sabaratnam Arulkumaran, President of FIGO and Professor Emeritus of Obstetrics and Gynaecology, St George’s, University of London say [2],

“New knowledge on use of tranexamic acid, one-to-one blood to plasma transfusion and advances in technology and techniques have reduced morbidity and mortality for postpartum haemorrhage.

References

1. WHO, 2012. WHO recommendations for the prevention and treatment of postpartum haemorrhage. World Health Organisation, Geneva. Accessed from http://apps.who.int/iris/bitstream/10665/75411/1/9789241548502_eng.pdf

2. RCOG, 2014. RCOG release: FIGO President discusses management of postpartum haemorrhage at Qatar conference, accessed from https://www.rcog.org.uk/en/news/rcog-release-figo-president-discusses-management-of-postpartum-haemorrhage-at-qatar-conference/