Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

The Global Alliance for Maternal and Child Health (GLAM): A Pioneer Organization for MCH Students

Currently, there is an insufficient representation of racial/ethnic minority groups in the maternal and child health (MCH) workforce. A student-run outreach organization, the Global Alliance for Maternal and Child Health (GLAM), seeks to address this disparity by increasing the representation of racial/ethnic minority groups in MCH workforce. Founded by students at Texas Southern University in Houston, Texas, United States, GLAM, seeks to establish productive alliances and create programs that would help improve the well-being of mothers, infants, and children locally, nationally, and internationally by engaging an active cadre of students passionate about MCH. Through community outreach and global engagement using evidence-based strategies, GLAM is committed to the elimination of health disparities plaguing the MCH population. Key words: • Maternal and Child Health • Pipeline program • Students-driven • Community outreach • Global engagement   Copyright © 2021 Harris et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited

Tuberculosis during pregnancy in the United States: Racial/ethnic disparities in pregnancy complications and in-hospital death.

Despite decades of efforts to eliminate tuberculosis (TB) in the United States (US), TB still contributes to adverse ill health, especially among racial/ethnic minorities. According to the Centers for Disease Control and Prevention, in 2016, about 87% of the TB cases reported in the US were among racial and ethnic minorities. The objective of this study is to explore the risks for pregnancy complications and in-hospital death among mothers diagnosed with TB across racial/ethnic groups in the US.This retrospective cohort study utilized National Inpatient Sample data for all inpatient hospital discharges in the US. We analyzed pregnancy-related hospitalizations and births in the US from January 1, 2002 through December 31, 2014 (n = 57,393,459). Multivariable logistic regression was applied to generate odds ratios for the association between TB status and the primary study outcomes (i.e., pregnancy complications and in-hospital death) across racial/ethnic categories.The prevalence of TB was 7.1 per 100,000 pregnancy-related hospitalizations. The overall prevalence of pregnancy complications was 80% greater among TB-infected mothers than their uninfected counterparts. Severe pre-eclampsia, eclampsia, placenta previa, post-partum hemorrhage, sepsis and anemia occurred with greater frequency among mothers with a TB diagnosis than those without TB, irrespective of race/ethnicity. The rate of in-hospital death among TB patients was 37 times greater among TB-infected than in non-TB infected mothers (468.8 per 100,000 versus 12.6 per 100,000). A 3-fold increased risk of in-hospital death was observed among black TB-negative mothers compared to their white counterparts. No racial/ethnic disparities in maternal morbidity or in-hospital death were found among mothers with TB disease.TB continues to be an important cause of morbidity and mortality among pregnant women in the US. Resources to address TB disease should also target pregnant women, especially racial/ethnic minorities who bear the greatest burden of the disease

A Surveillance System for the Maternal and Child Health (MCH) Population During the COVID-19 Pandemic

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the causative agent for coronavirus disease 2019 (COVID-19), and its ensuing mitigation measures have negatively affected the Maternal and Child Health (MCH) population. There is currently no surveillance system established to enhance our understanding of SARS-CoV-2 transmission to guide policy decision making to protect the MCH population in this pandemic. Based on reports of community and household spread of this novel infection, we present an approach to a robust family-centered surveillance system for the MCH population. The surveillance system encapsulates data at the individual and community levels to inform stakeholders, policy makers, health officials and the general public about SARS-CoV-2 transmission dynamics within the MCH population. Key words: • COVID-19 • Coronavirus • Maternal and child health • Family-centered • Surveillance system • Individual level data elements • Community level data elements • Community transmission of SARS-CoV-2   Copyright © 2020 Ajewole et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited

Racial/Ethnic adjusted odds ratios for pregnancy complications^a by TB status among pregnant women in the United States, 2002–2014.

<p>Racial/Ethnic adjusted odds ratios for pregnancy complications<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0194836#t003fn002" target="_blank">^a</a> by TB status among pregnant women in the United States, 2002–2014.</p

Racial/Ethnic in-hospital death rates (per 100,000 pregnancy-related hospitalizations) and adjusted odds ratios by TB status among pregnant women in the United States, 2002–2014.

<p>Racial/Ethnic in-hospital death rates (per 100,000 pregnancy-related hospitalizations) and adjusted odds ratios by TB status among pregnant women in the United States, 2002–2014.</p

Comparison of the rate (per 1,000 pregnancy-related hospitalizations) of selected pregnancy complications among hospitalized pregnant women aged 15–49 years of age, by TB status, United States, 2002–2014.

<p>Comparison of the rate (per 1,000 pregnancy-related hospitalizations) of selected pregnancy complications among hospitalized pregnant women aged 15–49 years of age, by TB status, United States, 2002–2014.</p

Distribution of socio-demographic and hospital characteristics among pregnant women 15–49 years of age, by TB status, United States, 2002–2014.

<p>Distribution of socio-demographic and hospital characteristics among pregnant women 15–49 years of age, by TB status, United States, 2002–2014.</p

Temporal trends in the prevalence of tuberculosis, by race/ethnicity, in the United States, 2002–2014.

<p>The X-axis represents the year of discharge and the Y-axis represents the rate of tuberculosis (per 100,000 pregnancy-related hospitalizations). Lines represent the trend estimated by joinpoint regression. Values represent the annual percent change (APC), point estimate (95% confidence interval). The ‘overall rate’ represents the rate of tuberculosis from January 1, 2002 to December 31, 2014, inclusive.</p