21 June 2013

Africa: Space-Age Technology to Reduce Maternal Deaths

Kuala Lumpur — Space-age technology, neoprene (the same material used for wet suits) and Velcro have gone into an experimental garment health experts hope can treat postpartum haemorrhage, the leading cause of maternal mortality worldwide.

A non-pneumatic anti-shock garment (NASG) - also called a "lifewrap" - is a half-body suit that is strapped onto a woman's lower legs and abdomen to slow bleeding and prevent shock due to blood loss.

"It [the lifewrap] works in two ways: it compresses the blood vessels in the lower part of the body, reversing shock by giving back oxygen to the heart, lungs and brain which are very oxygen-dependent tissues," said Suellen Miller, director of the Safe Motherhood Programme/Bixby Centre for Global Reproductive Health at the University of California San Francisco (UCSF) in the USA.

If it works as intended, pressure on the abdomen decreases the radius of the blood vessels and reduces overall bleeding.

According to the World Health Organization (WHO), postpartum haemorrhage - the loss of 500-1,000ml or more of blood within 24 hours after birth - accounts for nearly a quarter of maternal deaths globally and is the leading cause of maternal mortality in most low-income countries.

"Maternal death tracks the inequity between countries. Death from postpartum bleeding is nearly unheard of in the developed world," said Kate Gilmore, deputy executive director of the UN Population Fund (UNFPA).

The lifewrap, which evolved from a suit originally researched and developed by the US National Aeronautics and Space Administration (NASA) for their space programmes, was demonstrated to health experts at a recent maternal health conference in Kuala Lumpur, Malaysia.

Buying time

The lifewrap is not designed as a final solution to save women, but only a stabilizing measure to buy her time to be transferred to a health facility for surgery or blood transfusion.

According to US-based reproductive research body the Guttmacher Institute, in developing countries most women in remote communities give birth at home. The proportion of births in health facilities varies widely across the globe, according to the institute, from 50 percent of deliveries in eastern and western Africa to 99 percent in East Asia.

In 2010, the institute recorded 284,000 women in developing countries dying from pregnancy and childbirth complications.

"A woman has maybe two hours [from the onset of bleeding] before she suffers from lack of oxygen to her vital tissues and bleeds to death. Delays are killers," said Miller.

"Working in parts of the world where distance is the difference between life and death demands solutions that can begin in the community or in the home," said Purnima Mane, president and CEO of Pathfinder International, a US non-profit family planning and reproductive health organization.

Driving down costs

Clinical trials and studies on the use of the lifewrap were conducted by the Univeristy of California, San Francisco (UCSF) in Nigeria, Egypt, Zambia, Zimbabwe and India from 2004-2012. During that period, it was noted that use of the lifewrap decreased maternal death by up to 50 percent.

Though cautious not to attribute the drop to these wraps alone, and recognizing that multiple interventions may have been responsible for the decline, experts were encouraged by the correlation.

"Initial results from the testing of the garment are promising. We already have the [supporting] WHO policies. Now we want to encourage countries to review their maternal health protocols regarding postpartum haemorrhage and integrate the use of the lifewrap into their designed interventions," said Amie Batson, PATH chief strategy officer.

WHO guidelines on the management of postpartum haemorrhage call for timely medical intervention, which include administering drugs like oxytocin and misoprostol during the third and final stage of labour.

These drugs help contract the uterus, expedite delivery of the placenta and reduce blood loss.

In the event these drugs do not work, WHO published in 2012 guidelines promoting uterine compression, and the use of NSAGs specifically, as a temporary measure until appropriate care is available.

The lifewrap can be used up to 40 times and washed by hand with regular laundry detergent after each use. From an original cost of US$300 per garment, negotiations with manufacturers have driven down the cost to nearly $65.

Thus far, research and development of the wrap has been pursued jointly by UNFPA, Pathfinder International, UCSF, the US-based John D. and Catherine T. MacArthur Foundation and PATH.

[ This report does not necessarily reflect the views of the United Nations. ]

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