Tag: postpartum haemorrhage

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Lifesaving Post-partum Haemorrhage Intervention is Highly Cost-effective

On By ModernMedia
Photo by Anna Shvets on Pexels

A lifesaving package including early detection and bundled treatment for women who have post-partum haemorrhage has been found to incur minimal additional cost according to new analysis from 78 hospitals around the world.

In a paper published in Nature Medicine, a team of researchers working on the E-MOTIVE trial conducted an economic analysis to establish whether a package of interventions to objectively identify and treat post-partum haemorrhage (PPH) was cost effective.

Over 200 000 women from hospitals in Kenya, Nigeria, Tanzania and South Africa were included in the economic analysis of E-MOTIVE, with hospitals being randomly assigned to either the intervention or usual care groups. The intervention resulted in more than 1000 fewer PPH cases compared to the usual care group. The additional cost for E-MOTIVE was estimated to be, on average, an extra $0.30 per patient after adjustments for clinical factors including the proportion of patients with a clinical primary outcome event at each hospital, as well as for cluster and time-period considerations.

The economic analysis explored a range of costs for a key component of the E-MOTIVE package which is a calibrated blood collection drape, used for all women in the intervention group used to objectively measure blood loss. The analysis found that when the cost of the drape is around 1 USD, the average cost per patient could be comparable to usual care.

The cost of delivering the E-MOTIVE intervention could then be, on average, equivalent to usual care, which would represent a significant health benefit for women around the world

Professor Tracy Roberts

Tracy Roberts, Professor of Health Economics at the University of Birmingham and corresponding author of the study said:

“E-MOTIVE is clearly a cost-effective intervention for what is a lifesaving treatment for thousands of women around the world who may experience severe bleeding in childbirth. Our analysis of the E-MOTIVE trial shows that the costs incurred in delivering the package of treatments and the drape are on average minimal and represent really good value for money”.

“The drape forms a key part of the E-MOTIVE package, and should E-MOTIVE be widely adopted and the cost of drapes reduced to below $1, the economic benefits could be even more apparent. The cost of delivering the E-MOTIVE intervention could then be, on average, equivalent to usual care, which would represent a significant health benefit for women around the world.”

60% reduction in heavy bleeding

E-MOTIVE being found cost-effective comes after the publication of a landmark study published that found a 60% reduction in heavy bleeding for women experiencing PPH.

Postpartum haemorrhage (PPH) – defined as the loss of more than 500 mL of blood within 24 hours after birth – is the leading cause of maternal mortality worldwide. It affects an estimated 14 million women each year and results in around 70 000 deaths – mostly in low and middle-income countries – equivalent to 1 death every 6 minutes.

The study found that objectively measuring blood loss using a simple, low-cost collection device called a ‘drape’ and bundling together WHO-recommended treatments – rather than offering them sequentially – resulted in dramatic improvements in outcomes for women. Severe bleeding – when a woman loses more than a litre of blood after birth – was reduced by 60%, and they were less likely to lose their life.

There was also a substantial reduction in the rate of blood transfusions for bleeding, which is of particular importance in low-income countries where blood is a scarce and expensive resource.

Professor Arri Coomarasamy, who led the E-MOTIVE trial and is the Co-Director of the WHO Collaborating Centre on Global Women’s Health at the University of Birmingham said:

“This new approach to treating postpartum haemorrhage could radically improve women’s chances of surviving childbirth globally, helping them get the treatment they need when they need it.

“Time is of the essence when responding to postpartum bleeding, so interventions that eliminate delays in diagnosis or treatment should be gamechangers for maternal health. With this latest study showing that E-MOTIVE is extremely cost effective, and following WHO recommending the treatment bundle we hope that the intervention can quickly become the standard of care that will save many lives around the world.

Source: University of Birmingham

Categories : General Interest Obstetrics & GynaecologyTags : Leave a comment

Interview: A Simple Device Used after Birth can Help Save Lives, Says Award-winning Young Innovator

On By ModernMedia
Last month, she won the Mandela Rhodes Foundation’s award for social impact in Africa for a device that can help save the lives of women who suffer excessive bleeding after child birth. PHOTO: Nasief Manie/Spotlight

By Biénne Huisman for Spotlight

As a child growing up in the Ugandan capital of Kampala, Maureen Etuket used a screwdriver to dismantle electronic appliances and toy trucks. “I was around eight, nine years old,” she says. “I guess it just excited me.”

Slightly over a decade later, this curiosity is driving her quest to find solutions to public healthcare challenges.

Last month, Etuket’s Smart PVD device [Postpartum Haemorrhage Volumetric Drape] won the Mandela Rhodes Foundation’s award for social impact in Africa – the 2023 Äänit Prize – with a cash grant of $38 000. At the awards ceremony in Cape Town, judges described the device as “a brilliantly practical intervention that can immediately and directly improve outcomes for patients”.

Inside the Anatomy Building on the University of Cape Town (UCT)’s Health Sciences campus, Etuket explains that she and her team devised a prototype after spending three months in maternity wards at Kawempe National Referral Hospital in Kampala.

“We went almost every day. We had day shifts and night shifts,” she recalls. “I started asking the question to nurses and midwives, how do you know that a woman is likely to get to PPH?” PPH or post-partum haemorrhage is excessive bleeding after a baby’s birth, which could cause a severe drop in blood pressure leading to shock and death if not treated.

“Like, how do you tell? What criteria do you use? And the nurses told me that they had been doing this for a long time. They said they just observe and know. And I thought to myself, if that was working, we would have [fewer] women dying from PPH.”

How does the Smart PVD device work?

“There’s something already on the market – an under-buttock drape bag attached to the bed while a woman is giving birth, which measures amount of blood loss,” says Etuket. “[It’s] basically a bag where the blood flows into. We then created an electronic module that has a probe and a buzzer, which we put inside this bag, and it gives a beeping sound when the blood has reached a certain level. This alarm alerts a midwife to recognise the need to attend to a particular case. So the blood collection module is disposable. And the electronic module, which has the probe and the buzzer, is reusable.”

Etuket declines to share pictures, citing intellectual property rights.

“I really think that this is one of the simplest innovations,” she says. “We’ve been pitching it and talking about it, and everyone that listens is just like it’s common sense, right?” Apart from the Äänit Prize, they have received $16 000 from the Makerere University’s research and innovations fund and $55 000 from the science and technology secretariat in Uganda.

Moving to Cape Town

Etuket moved to Cape Town in 2021, courtesy of a Mandela Rhodes Foundation scholarship. “I applied for a Masters in health innovation at UCT under the Mandela Rhodes Foundation. So, I’m Christian. I believe in the hand of God in everything I do. I made just that one application. Like, there were options to put three universities, three courses, all that. I just wanted health innovation at UCT, and I got it.”

Her Masters supervisor was Professor Sudesh Sivarasu, internationally renowned for medical device innovation and head of UCT’s MedTech laboratory.

“There were so many questions we had at Pumzi Devices about how to transition an innovation to the market and no one really had the answers because it’s a new space. At a certain point, some of us had to travel to Scotland just to sit with experts to guide us through a protocol design process. No one in Uganda really had a clear picture of [this] so that’s what prompted me to do the Masters in health innovation,” says Etuket.

Find your purpose

Presently, she is pursuing a PhD in industrial engineering at Stellenbosch University under the supervision of Professor Sara Grobbelaar and Dr Faatiema Salie. Yet she spends most of her time at UCT, where Sivarasu is her external co-supervisor. Etuket’s PhD’s working title is “Exploring the development of a localisation roadmap for medical devices in South Africa using an Innovation Systems Framework”. She explains that this line of study – systems engineering – is drawing her thinking wider to understand the systems around biomedical design and innovation.

Going forward, Etuket will continue to lecture students back home in Uganda – online – while being open to further her learning and practice where it is apt or required around the world.

At 28 years old, Etuket’s drive and achievements make her a role model for many. However, she is reluctant to wear the label of “a pioneering young black woman,” voicing caution over mantels based on race and gender. “I notice that when we start to have those mindsets, we may end up trampling on people, on men. We have to work together. There is room for all of us,” she says.

The first born of four siblings, Etuket’s father was a computer engineer and her mother an accountant and businesswoman. Elaborating on leadership, she says, “I think it’s important to pray for people. That’s where we get guidance on how to lead. I tell people, not everyone should do a PhD, maybe not everyone should do a Masters, but find your purpose and fulfil it.”

Republished from Spotlight under a Creative Commons 4.0 Licence.

Source: Spotlight

Categories : Obstetrics & GynaecologyTags : Leave a comment

New Intrauterine Device Rapidly Controls Postpartum Haemorrhage

On By ModernMedia
Photo by Jonathan Borba on Unsplash

A study led by Columbia University obstetricians has shown that a new intrauterine device can rapidly control postpartum haemorrhage, a major cause of severe maternal morbidity and death, in real-world situations.

“Our findings show that the device is an important new tool in managing postpartum bleeding,” says Dena Goffman, MD, professor of obstetrics and gynaecology at Columbia University and senior author of the study, which is published in the journal Obstetrics & Gynecology.

“We had previously shown that the device worked well with patients who were experiencing relatively minor bleeding, so it’s really reassuring to see that the device worked almost as well among a wider range of patients and when used by many different doctors.”

Overall, the device succeeded in controlling haemorrhage in 93% of vaginal deliveries and 84% of caesarean deliveries.

Major cause of severe maternal morbidity and death

Shortly after birth and delivery of the placenta, the uterus contracts and closes off the blood vessels that nourished the placenta. Failure of the uterus to contract after delivery can result in prolonged and excessive blood loss, which may necessitate blood transfusions, ICU admission, or surgery to try to stop the bleeding and, if needed, removal of the uterus.

“Less than 10% of people who give birth will have excessive postpartum bleeding, but when it happens, it can get really serious really fast,” says Goffman, who co-authored the most recent guidelines from the American College of Obstetrics and Gynecology for the treatment of postpartum haemorrhage.

Current treatment options not ideal for all patients

To stop excessive bleeding, clinicians usually start by manually stimulating the uterus and giving medications that help the uterus contract, but some of these drugs are not safe for patients with hypertension or asthma. When medication fails or isn’t an option, patients may be treated with a balloon-like tamponade device that is inserted into the uterus and controls bleeding by placing pressure on the uterine wall.

Balloon tamponade devices have a high success rate, but this treatment has an impact on the patient and family experience. “The balloon often stays in the uterus for 12 to 24 hours until the uterus is well-contracted, and during that time the patient can’t sit up in bed, can’t walk around, can’t easily care for the baby,” Goffman says.

New device approved in 2020

In 2020, the FDA approved a new intrauterine device to control postpartum bleeding that uses low-level suction to promote uterine contractions.

“With postpartum haemorrhage being one of the most preventable causes of maternal morbidity and mortality, practice-changing innovation was needed to better equip our teams and care for our patients,” says Mary D’Alton, MD, chair of the Department of Obstetrics & Gynecology at Columbia University Vagelos College of Physicians and Surgeons and national leader of the clinical trial that first tested the safety and efficacy of the device.

In that initial trial, which led to FDA approval, the device controlled bleeding in a median of 3 minutes among 106 patients experiencing relatively minor blood loss after childbirth and was removed about 3 hours after insertion. Most patients in the trial delivered vaginally. The trial also excluded patients with preterm births < 34 weeks.

Highly effective in real-world conditions

The current study, which included more than 800 patients giving birth at 16 hospitals, was designed to study the effectiveness of the new device outside of a controlled clinical trial. One third of the patients in the new study had a caesarean, and 50 patients had a preterm birth < 34 weeks.

Median blood loss volume before device insertion was also higher in the new study, reflecting a greater range in blood loss, with some patients losing substantial amounts of blood (up to 3000mL). Most patients had been treated with medications to manage postpartum bleeding prior to device insertion.

Treatment with the new device was successful in 93% of patients who had a vaginal birth and 84% of patients who had a caesarean birth (similar to efficacy with intrauterine balloon devices). For most patients, the device brought bleeding under control in five minutes. Treatment success rates were higher in patients with less blood loss prior to device insertion.

Next steps

The researchers say that early recognition of postpartum hemorrhage and timely intervention are crucial in managing the condition and preventing potentially life-threatening complications.

“Postpartum haemorrhage is a treatable condition,” Goffman says. “Delivery teams need to be attuned to recognising it quickly and managing it in a seamless and sequential manner before a patient experiences significant blood loss.”

Additional studies comparing the new device with other treatments for postpartum haemorrhage are being planned to determine if using the device earlier produces better outcomes.

“Until we have more data, we’re using the new intrauterine device after medications have been tried,” Goffman says. “But for patients with underlying conditions who cannot be treated with one or more of our available medications, the device is a critically important tool to have.”

Source: Columbia University Irving Medical Center