McClure Elizabeth M, Jones Bonnie, Rouse Doris J, Griffin Jennifer B, Kamath-Rayne Beena D, Downs Allan, Goldenberg Robert L
Department of Social, Statistical and Environmental Health Sciences, Research Triangle Institute, Durham, North Carolina.
Department of Pediatrics, Perinatal Institute, Cincinnati Children's Hospital, Cincinnati, Ohio.
Am J Perinatol. 2015 Apr;32(5):469-74. doi: 10.1055/s-0034-1390347. Epub 2014 Oct 7.
Postpartum hemorrhage (PPH) is a major cause of maternal mortality, with almost 300,000 cases and ~72,000 PPH deaths annually in sub-Saharan Africa. Novel prevention methods practical in community settings are required. Tranexamic acid, a drug to reduce bleeding during surgical cases including postpartum bleeding, is potentially suitable for community settings. Thus, we sought to determine the impact of tranexamic acid on PPH-related maternal mortality in sub-Saharan Africa.
We created a mathematical model to determine the impact of interventions on PPH-related maternal mortality. The model was populated with baseline birth rates and mortality estimates based on a review of current interventions for PPH in sub-Saharan Africa. Based on a systematic review of literature on tranexamic acid, we assumed 30% efficacy of tranexamic acid to reduce PPH; the model assessed prophylactic and treatment tranexamic acid use, for deliveries at homes, clinics, and hospitals.
With tranexamic acid only in the hospitals, less than 2% of the PPH mortality would be reduced. However, if tranexamic acid were available in the home and clinic settings for PPH prophylaxis and treatment, a nearly 30% reduction (nearly 22,000 deaths per year) in PPH mortality is possible.
These analyses point to the importance of preventive and treatment interventions compatible with home and clinic use, especially for sub-Saharan Africa, where the majority of births occur at home or community health clinics. Given its feasibility to be given in the home, tranexamic acid has potential to save many lives.
产后出血（PPH）是孕产妇死亡的主要原因，在撒哈拉以南非洲地区，每年有近30万例产后出血病例，约7.2万人因产后出血死亡。需要适用于社区环境的新型预防方法。氨甲环酸是一种可减少包括产后出血在内的手术过程中出血的药物，可能适用于社区环境。因此，我们试图确定氨甲环酸对撒哈拉以南非洲地区与产后出血相关的孕产妇死亡率的影响。
我们创建了一个数学模型来确定干预措施对与产后出血相关的孕产妇死亡率的影响。该模型基于对撒哈拉以南非洲地区当前产后出血干预措施的综述，纳入了基线出生率和死亡率估计值。基于对氨甲环酸文献的系统综述，我们假设氨甲环酸降低产后出血的疗效为30%；该模型评估了在家中、诊所和医院分娩时预防性和治疗性使用氨甲环酸的情况。
仅在医院使用氨甲环酸，产后出血死亡率降低不到2%。然而，如果在家中和诊所环境中都能获得氨甲环酸用于产后出血的预防和治疗，则产后出血死亡率有可能降低近30%（每年近2.2万例死亡）。
这些分析表明了与家庭和诊所使用相兼容的预防和治疗干预措施的重要性，特别是对于撒哈拉以南非洲地区，该地区大多数分娩发生在家中或社区卫生诊所。鉴于氨甲环酸可在家中使用的可行性，它有挽救许多生命的潜力。
