Before I started my rotations, I was thinking about specializing in trauma surgery. And so every time I am able to see how trauma intersects with a rotation, I get excited. On my OBGYN rotation, there are a lot of patients who have postpartum hemorrhage (PPH). That means that during labor, there is greater than 500mL (or 1000mL) of blood loss during and after delivery. It’s a huge cause of maternal mortality, particularly in the developing world. In fact, 99% of cases of PPH are in the developing world.
The reason why I got interested in the topic is that there was a study, called the WOMAN trial, that looked at a drug commonly used in trauma surgery. This drug has been shown to be effective in reducing blood-related mortality in trauma patients in the military. The WOMAN trial looks at the drug’s effect on outcomes in postpartum hemorrhage.
The study was huge! More than 20,000 patients in 21 countries worldwide received either the drug or a placebo. The study looked at a few outcomes: mortality, the risk of surgical intervention, the risk of organ failure or sepsis, and thromboembolic events. What the study discovered was that if given within the first 3 hours, this drug reduced maternal mortality due to hemorrhage. It also reduced the need for laparotomies to control bleeding.
Currently, the WHO and ACOG (the American Congress of Obstetricians and Gynecologists) indicate that this new method does have a role, but is not the first line. Currently, the first line treatment consists of uterotonics, since the number one cause of PPH is uterine atony. But the WOMAN study does indicate promise for incorporating novel approaches to a major problem!