Postpartum hemorrhage (PPH), excessive bleeding that occurs shortly after birth, is the leading cause of maternal mortality in low-income nations. It can affect new mothers anytime and anywhere, though, and according to the World Health Organization (WHO), it’s the primary cause of around a quarter of all maternal deaths globally.
Clearly, it’s a serious problem. A treatment is available, but because of how it works, it’s not available to those living in remote locations, particularly in warm, arid parts of the world. A new study, spearheaded by Swiss-based Ferring Pharmaceuticals, is now presenting a new way to treat PPH that could close this dangerous gap.
Writing in the New England Journal of Medicine, the team explains that data from nearly 30,000 women indicates that carbetocin, a heat-stable compound, is just as effective at stemming PPH as oxytocin, the current standard of care. If corroborated, this research – conducted in conjunction with the WHO – could end up saving countless lives in countries with inadequate health infrastructures.
Primary PPH is defined as a loss of more than 500 milliliters of blood from the female genital tract 24 hours after birth. (Secondary occurs from those 24 hours up to six weeks post-birth.) It’s not always fatal, but it can be – multiple organ failure is a possibility, for example, if it’s not stopped.
The causes of PPH are varied, but include a failure of the womb to properly contract after birth, the presence of part of the placenta in the womb, or an infection in the womb’s lining. This in itself is an ongoing field of research.
In order to help prevent PPH, women are offered an injection of the hormone oxytocin as birth is taking place. This helps to stimulate contractions, and helps push the baby out safely.
The problem with oxytocin is that it must be stored and transported in a narrow temperature range: 2-8°C (35.6-46.4°F). This is fine in wealthy nations with good health infrastructures.
However, in many less developed nations, transporting oxytocin over distances to those that need it, or even just keeping it at room temperature, sees it degrade and become less effective. Around 70,000 lives are lost as a result of this every single year, so how can this be prevented?
This team turned to a formulation of carbetocin, a drug that’s used to prevent the incomplete contraction of the uterus post-birth. It’s normally used on mothers that have undergone a C-section, but the researchers wondered if it could apply to vaginal birth too.
Importantly, the carbetocin they used was heat-stable, meaning that, unlike oxytocin, it didn’t require cold storage. Data shows that, for at least 36 months, it remains stable at 30°C (86°F) and in high humidity.
The experiment conducted to test out this compound was huge: This randomized, double-blind trial involved 29,645 women, spread across 23 sites in 10 countries – from Singapore to Uganda, from India to the UK – between 2015 and 2018. In it, the efficacy of intramuscular injections of carbetocin was compared and contrasted with standard applications of oxytocin.
As it turns out, PPH was pretty much the same whether patients were given the new treatment or the conventional one.
The frequency of blood was ever so slightly higher using the carbetocin, but not in a particularly statistically significant way. There was also no difference in terms of any adverse effects.
Heat-stable carbetocin is not the only potential treatment for PPH out there, but the fact that this compound doesn’t require cold storage is a huge deal. It’s not all about stability either: the lack of a need for a cold storage mechanism means that the drug can be transported and retained cheaply.
According to a somewhat conservative estimate, PPH causes the death of a woman every 10 minutes. Ninety-nine percent of these deaths occur in poorer countries. Is carbetocin the lifesaver they’re looking for?