Tuesday December 11, 2018

Low-cost Drug Can Save lives of 1 in 3 Mothers who will otherwise bleed to Death after Childbirth, especially in India and Africa

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A pregnant woman (Representative image) Pixabay
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A low-cost and widely available drug could save the lives of 1 in 3 mothers who would otherwise bleed to death after childbirth, according to a new study.

Severe bleeding, known as postpartum hemorrhage, or PPH, is the leading cause of maternal death worldwide, killing more than 100,000 women every year. Even for mothers who survive, it is a painful and traumatic experience.

The world’s poorest countries, especially in Africa and India, are the worst hit.

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Drug from 1960s

But there is new hope. In the 1960s, Japanese researchers developed a drug called tranexamic acid, which works by stopping blood clots from breaking down. But they could not persuade doctors to try the drug for treating PPH.

The London School of Hygiene and Tropical Medicine has done just that, in a trial involving 20,000 women in 21 countries, mainly in Africa and Asia. The results show tranexamic acid reduces the risk of bleeding to death by almost a third, with no side effects for either mothers or babies.

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Dr. Nike Bello, a consultant obstetrician and gynecologist in Nigeria, said that “if a drug can prevent hysterectomies, a drug can prevent death, a drug can minimize the amount of blood we need, then that is a good thing, all over the world.”

Refinements needed

But there are challenges to getting the drug where it is needed. First, the doctors must know about its effectiveness, said professor Ian Roberts of the London tropical medicine school, who led the latest research.

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“We want everyone to hear about the results,” he said. “But then there are the nitty-gritty issues. Is the treatment available in the hospital? Do doctors and midwives know how to use it? It is heat stable, so it does not have to be kept in the fridge. It is relatively inexpensive — it is about a dollar. And no child should grow up without a mother for lack of a treatment that costs a dollar.”

In the trial, tranexamic acid was given via a drip. Researchers say the next step is to find an easier way to administer the drug so it can be used in clinics and rural settings across the world. (VOA)

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Once a Cesarean, Always a Cesarean; Is Not True Anymore Say Medical Experts

Kapila said that it is the patient's decision that gets greater priority.

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Pregnancy, Breast Cancer
Pregnancy is safe for breast cancer survivors: Experts Flickr

It is said that “once a cesarean, always a cesarean”. It is commonly believed that a woman who has undergone a c-section delivery will have to opt for the same method while giving birth to her next child. But medical experts are trying to dispel this myth.

According to them, Vaginal Birth After Cesarean, commonly termed as VBAC, can be adopted by any mother for her second or third birth if she wishes to avoid the complications of c-section delivery.

“Any woman with a previous caesarean section can attempt a VBAC. The majority of women, despite having a c-sect delivery, often prefer a vaginal delivery. Women are showing more courage towards this. It is safe and the established hospitals are providing full support to mothers who plan to go for a vaginal delivery,” Dr Mukta Kapila, Director, Obestrics and Gynaecology, at Fortis Gurgaon, told IANS.

Dr Rinku Sengupta, who had been associated with the Sitaram Bhartia Institute of Science and Research as Maternity Programme Head, said that in recent times two out of three women with a previous c-section deliveries attempt a VBAC and almost 90 per cent of them are successful.

pregnant, cesarean
However, when it comes to vaginal delivery, the first thought that crosses most women’s’ minds is of the labour pain which develops a fear of the VBAC, Pixabay

“Only pregnant women above the age of 40 are more at risk for stillbirths and unsuccessful VBACs. Careful consideration should be given to the timing of delivery in these cases,” Sengupta said.

Sengupta explained that obesity is also a factor that could potentially increase the risk of uterine rupture and this can be a limitation for VBAC. She also pointed to a study that 85 per cent of normal weight women (BMI 18.5-24.9) achieved successful VBAC, while only 61 per cent of morbidly obese (BMI 40 or more) women achieved VBAC.

Kapila said that before opting for a VBAC, the history of the previous delivery needed to be considered.

“Under which conditions and circumstances, a caesarean was conducted — in emergency or breach — first needs to be identified. The mother, planning for vaginal delivery, should at least maintain a minimum gap of two years before opting for the second or third child,” she stated.

Often c-section delivery leaves a scar in the uterus, which, according to the medical experts, is a vital factor to be considered before they suggest a VBAC.

pregnant, cesarean
The baby girl was born through Caesarean section in a government hospital in Karnataka. Image source: Prakash Hassan, BBC

According to the American Congress of Obstetricians and Gynecologists (ACOG), some uterine scars (such as vertical scars which are now rare) are more likely than others to cause a rupture during VBAC.

“Therefore, it is important to show medical records of prior cesarean delivery so that doctors can assess viability for a VBAC in case of increased risk of uterine rupture.Sometimes women are discouraged from trying for a VBAC because of a thin scar,” Sengupta noted.

However, when it comes to vaginal delivery, the first thought that crosses most womens’ minds is of the labour pain which develops a fear of the VBAC.

“Everyone knows that labour is painful and even an epidural injection cannot make labour 100 per cent pain-free. But with proper physical and emotional support, continuous one-on-one presence of a skilled care provider or birth partner, and use of natural methods like warm showers, massages and exercises, most mothers cope very well with labour pain,” Sengupta explained.

Also, the fear of labout pain, according to the experts, can be dispelled by timely counselling and talking about the benefits and less risk involved in VBAC.

Consumption of even one or two cups of coffee per day by expectant mothers can put their babies into a higher risk of being obese at school age.
A Pregnant Woman, Pixabay

Yet, there is always the chance that a VBAC might be called off at the last moment even if the mother didn’t face any complications during pregnancy.

“A doctor may suggest an emergency c-section if complications occur during labour. If the baby is not able to tolerate labour or the contractions aren’t effective in moving the baby down the birth canal, then a cesarean may be the best way to deliver the baby,” Sengupta explained.

Also Read: Anaemia During Pregnancy Might Spike Up Risk of Heart Disease

Kapila said that it is the patient’s decision that gets greater priority.

“There is no point in pushing a mother for VBAC if she is not mentally prepared or feels scared or delivery complications arise at the last moment. Although the doctors will recommend vaginal birth, the patient’s life cannot be put at risk,” Kapila said. (IANS)