Women with postpartum haemorrhage (PPH) in 193 centres in 21 countries enrolled in the international WOMAN trial (n= 20,060).
Intravenous injection of 1 g of tranexamic acid (n= 10,051).
Matching placebo (n= 10,009).
There were 483 maternal deaths in developing countries. Case fatality rates were 3.0% in Africa and 1.7% in Asia. Nearly three quarters of deaths were within 3 hours of delivery and 91% of these deaths were from bleeding. Women who delivered outside a participating hospital (12%) were three times more likely to die than those who delivered in hospital. Key contributory factors highlighted by clinicians were: late presentation, maternal anaemia and poor infrastructure.