Back in the 1960s, a female doctor in Japan created a powerful drug to help mothers who hemorrhage after childbirth.
The medicine is inexpensive to make. It's safe to use. And it stops bleeding quickly by helping keep naturally forming blood clots intact.
The drug's inventor, Utako Okamoto, hoped that the drug called tranexamic acid would be used to help save moms' lives.
Every year about 100,000 women around the world die of blood loss soon after a baby is born. It's the biggest cause of maternal death worldwide.
"It was Okamoto's dream to save women," says Haleema Shakur, who directs clinical trials at the London School of Tropical Medicine and Hygiene. "But she couldn't convince doctors to test the drug on postpartum hemorrhaging."
And so tranexamic acid has gone largely unused in maternity wards for decades.
In a massive international trial, Shakur and her collaborators have shown that tranexamic acid decreased the risk of death from blood loss associated with childbirth by about a third. (Previous studies have looked at the drug's use in reducing bleeding deaths after traumatic injuries.)
In the study, women who were diagnosed with heavy bleeding, or postpartum hemorrhage, after a vaginal birth or cesarean section received either the drug or a placebo.
About 1.2 percent of women who got tranexamic acid within three hours of a hemorrhage died, compared with 1.7 percent of the women who got the placebo.
Side effects weren't a serious problem. The medicine didn't increase the risk of dying of other causes during the procedure, Shakur and her colleagues report in The Lancet journal.
The study included 20,000 women, in nearly 200 hospitals, across 21 countries, including rich ones, like the U.K., and poorer ones, like Pakistan and Nigeria.
The medicine is inexpensive. It cost about $3 in the U.K., and a quarter of that in Pakistan, for instance.
"If you can save a life for approximately $3, then I believe that's worth doing," Shakur says.
It's rare to have a new tool for helping women during childbirth, says Felicia Lester, an OB-GYN at the University of California, San Francisco, who also works in Uganda and Kenya.
"I think the study is exciting," she says. "I'm usually cautious in saying that. But it looks like tranexamic acid has the potential to save lives."
The drug even helped women when doctors used it along with other common medications, such as oxytocin, says Margaret Kruk, a global health researcher at Harvard University.
"Tranexamic acid offers an additional benefit above and beyond what is being done for women already," she says.
Now, though, the big question is how to make sure this drug is available for women who need it the most — women in the poor, remote areas of the world, where maternal mortality is the highest.
"That's, I think, the million dollar question," Kruk says. "We in global health have a number of tools that seem very effective in large clinical trials. But then when it comes time to use them for all women, we see very large gaps in implementation."
AUDIE CORNISH, HOST:
Now promising news for moms-to-be around the world. Doctors say they have found a drug that prevents deaths during childbirth. It could save tens of thousands of lives each year, especially in poor countries. NPR's Michaeleen Doucleff reports.
MICHAELEEN DOUCLEFF, BYLINE: Every two minutes, a woman around the world dies in childbirth. There are many reasons why, but the most common is blood loss. Dr. Rizwana Chaudhri is an OB-GYN in Pakistan. She tells The Lancet Journal that women bleed to death every day in clinics there.
RIZWANA CHAUDHRI: You can't even think of that in the developed world. But over here, this is an everyday thing, which goes on and on and on.
DOUCLEFF: For decades, doctors have known about a drug that could possibly help. It's inexpensive and widely available, but it hadn't been tested thoroughly. So an international team of doctors put together a massive study with 20,000 women across 21 countries.
Dr. Haleema Shakur at the London School of Hygiene and Tropical Medicine helped lead the trial. She tells The Lancet Journal, where the results appear, that after 10 years of work, they finally have very good news.
HALEEMA SHAKUR: The trial was a huge success.
DOUCLEFF: The drug called Tranexamic acid was shown to be safe for women. When it's given quickly after childbirth, it reduces the risk of bleeding to death by a third.
SHAKUR: We've shown it to be effective, that it can save lives. And I hope every single doctor who sees a woman with postpartum hemorrhage makes sure he or she considers using Tranexamic acid in that woman they're seeing.
DOUCLEFF: Many researchers praised the study. Felicia Lester is an OB-GYN at the University of California, San Francisco who also works in Uganda and Kenya. She says having a new way to help women during childbirth is quite rare.
FELICIA LESTER: I think it's exciting, actually, and I am usually cautious to say that kind of thing. But it has the potential to save lives.
DOUCLEFF: But she says there's still a huge challenge with this drug and that's getting it to the women who need it the most, those who live in poor remote corners of the world. Michaeleen Doucleff, NPR news. Transcript provided by NPR, Copyright NPR.