Haleema Shakur Still

And we went in believing something and the result shocked us into learning even more because what did we learn?

We didn't see a benefit of tranexamic acid on our primary outcome, which was the clinical diagnosis of postpartum hemorrhage.

Yet we did see a reduction in the really bad outcomes, which was need for surgery and death, although the numbers were very small and it wasn't our primary outcome.

So the signal was still exactly as we had seen before.

But what we hadn't banged on was the fact that how did doctors give a diagnosis of postpartum hemorrhage in women who were anemic?

And it had nothing to do with

the actual blood volume loss.

It was more to do with the clinical state of the woman in front of them.

So with anemia, you already have increased heart rate, lower blood pressure.

Those are also signs of shock.

So combine that with any bleeding, they will very quickly give it a diagnosis of postpartum hemorrhage.

So we think that women weren't getting in trouble because they were bleeding a lot.

They were getting into trouble because of their anemia, because doctors were seeing

These classic signs associated with anemia, i.e.

the signs of shock, high heart rate, low blood pressure, and some bleeding, and they were calling it postpartum hemorrhage.

So if you had your outcome is something that can vary enormously, there's no clarity as to what it is.

Right.

We didn't see a difference between the two treatment groups, but it taught us a lot about anemia itself and how sick women were going into giving birth with anemia.

Well, the other things we discovered with the Woman 2 trial is that women with anemia were more likely to have a baby die in their uterus before birth.

They were more likely to have smaller babies.