Heat Therapy Could Save Thousands of Women's Lives

(CNN) – A new formulation of a drug that prevents excessive bleeding after childbirth could save thousands of lives of women around the world, according to a new study.

Postpartum haemorrhage (HPP) – or excessive bleeding after childbirth – claims the lives of tens of thousands of women a year and is usually treated with a drug called oxytocin.

But the new research found a new version of the drug carbetocin, which does not require refrigeration, is as effective as oxytocin in preventing this form of bleeding. Oxytocin, should be stored at cool temperatures – between 2 and 8 degrees Celsius (35.6-46.4 degrees Fahrenheit). It is already known that carbetocin is safe and effective in preventing bleeding, but this reformulation used in the study offers an alternative without the challenge of transport and cold storage.

In countries that do not have the storage capacity to contain oxytocin, many women are being denied this life-saving treatment, according to the WHO study released on Wednesday .

"For many years, we have been looking for a heat stable product that could be as effective as oxytocin, and today we can say that we have it," said Mariana Widmer, Technical Manager, Department of Reproductive Health, WHO. Research, lead author of the study.

Carbetocin is very similar to oxytocin. But instead of breaking down at low temperatures, it has been shown that carbetocin remains stable at 30 degrees Celsius (86 degrees Fahrenheit) and 75% relative humidity up to 36 months. (Oxytocin is more sensitive to moisture than to heat.)
"Giving medications to contract the uterus after childbirth is considered the cornerstone of efforts to prevent postpartum hemorrhage," said Ian Roberts, professor of epidemiology and post-partum hemorrhage. public health at the School of Hygiene and Tropical Medicine of London. l & # 39; study. "Oxytocin is the medicine currently recommended, but it is heat sensitive and is losing power in hot climates – the kinds of places where many mothers die."

That is why the researchers compared the efficacy of carbetocin and oxytocin and demonstrated that carbetocin can withstand high temperatures and that it is as safe and effective as oxytocin to prevent HPP, defined as a blood loss of at least 500 ml after vaginal delivery.

To do this, they followed 29,645 women from 23 different sites in 10 different countries, including Argentina, Egypt, India, Kenya, Nigeria, Singapore, the United States, and the United States. South Africa, Thailand, Uganda and the United Kingdom between 2015 and 2018.

"The development of a drug to prevent postpartum hemorrhage that continues to remain effective in hot, humid conditions is very good news for the millions of women giving birth in some parts of the world without access to reliable refrigeration "Metin Gülmezoglu, coordinator of maternal and perinatal health and prevention of the team of unsafe abortion to WHO, who also worked on the project. ;study.

About 14 million women worldwide suffer from HPP each year, and 70,000 women die as a result, according to the study published Wednesday in the New England Journal of Medicine. This is the most common cause of death among women who give birth. The researchers noted that between 2003 and 2009, HPP caused 661,000 deaths worldwide. Most of these deaths occurred within 24 hours of birth.

The HPP is largely preventable in the developed world, but in developing countries, where maternal health services are less prevalent, the disease causes up to 60% of maternal deaths.

"This is a truly encouraging new development that can revolutionize our ability to keep mothers and babies alive," said Dr Tedros Adhanom Ghebreyesus, WHO Director-General in a statement.

But there are some caveats, the most obvious, about the feasibility of deploying carbetocin.
"Thermostable carbetocin is much more expensive than oxytocin, and the pharmaceutical company that has an agreement with the WHO to make it available at a reasonable price in poor countries, but the devil is in the detail Roberts said.

"How much will it cost, what countries will receive it, for how long, will it reduce the availability of cheaper oxytocin, and poor mothers from rich countries?" All of these factors must be taken into account. "

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