The Impact of Cardiovascular Diseases on Maternal Deaths in the Nordic Countries

Abstract

hemorrhage. The World Maternal Antifibrinolytic (WOMAN) trial conducted in women with PPH reported that TXA had no effect on all-cause mortality; however, the trial mostly conducted in low-resource settings. This study aimed to determine whether administering 1 g of TXA intravenously during active PPH (blood loss ≥ 1000 mL) impacted the rate of maternal morbidity.This retrospective, comparative study examined delivery data between November 9, 2016 and June 30, 2019 at a large regional maternal hospital in Australia. All women at term gestation with a vaginal, singleton birth were included in the study. Women with <1000 mL blood loss, with multiple gestation, preterm births, delivery before hospital arrival, and cesarean deliveries were excluded from the study. Data on maternal demographics, onset of labor, length of labor stages, augmentation of labor, perineal trauma, delivery mode, infant birth weight, initial management of third stage, PPH surgical and medical management, ICU admission, blood product administration, iron infusion, and postnatal hemoglobin was gathered. Data were analyzed using univariate logistic regression models. The primary outcome was composite maternal morbidity. Secondary outcomes included TXA-related adverse events, uterine balloon tamponade use for PPH, and need for post-partum IV iron infusion.Of the 392 total cases, 158 women received 1 g of TXA intravenously within 3 hours of delivery. No difference was found in maternal morbidity [odds ratio (OR): 0.86, 95% confidence interval (CI): 0.57-1.29, P = 0.46] or use of iron infusion postpartum (OR: 1.44, 95% CI: 0.92-2.27, P = 0.11). There was a significant decrease in uterine balloon tamponade utilization after TXA guideline implementation (OR: 0.33, 95% CI: 0.16-0.67, P < 0.01).This retrospective study showed no difference in PPHrelated maternal morbidity or mortality but did show a reduction in intrauterine balloon use with early TXA administration in a high-income setting. Future studies should look at the impact TXA practice guidelines may have on cesarean delivery patients.