Influence of the WOMAN trial on national wide standard operating procedures for treatment of postpartum hemorrhage

Abstract

Background: Postpartum hemorrhage is the leading cause of maternal death. Recently, the WOMAN trial showed that early administration of tranexamic acid leads to a reduced mortality due to bleeding. The aim was to study whether the results of the WOMAN trial have influenced the institutional standard operating procedures in treating postpartum hemorrhage.

Methods: We performed a paper-based survey during the German Perinatal Congress in 2017 located in Berlin. A total of thirteen questions covered the fields of incidence, training, and treatment of postpartum hemorrhage.

Results: 250 questionnaires were handed out to all participants of three different sessions during the congress. 72 questionnaires were returned, resulting in a return rate of 29%. 94% (n = 65) of all participants stated that they had implemented a standard operating procedure to treat postpartum hemorrhage prior to the WOMAN trial. 18 of these standard operating procedures were revised after the publication of the WOMAN trial, resulting in an early inclusion of tranexamic acid in 100% of all standard operating procedures.

Conclusion: We recognized a correlation between the publication of the WOMAN trial and the administration of tranexamic acid at an early time-point in all standard operating procedures of the participating institutions to treat postpartum hemorrhage. In all those clinics whose algorithms initially did not contain any tranexamic acid, it was supplemented. This resulted in a 100% implementation of tranexamic acid.

Keywords: Coagulation; Hemostasis; Obstetric labor; Postpartum hemorrhage; Pregnancy; Pregnancy complications; Tranexamic acid.