Postpartum hemorrhage is the leading cause of maternal mortality worldwide. New research suggests pairing a low-cost device with a quick bundle of treatments to stop blood loss.
A low-cost device, paired with a quick bundle of treatments to stop blood loss, could help prevent an estimated 22,000 maternal deaths per year, according to research released Tuesday.
The study, published in the New England Journal of Medicine, investigated ways to detect and reduce the prevalence of postpartum hemorrhages — the leading cause of maternal mortality worldwide and the second-leading cause in the U.S., behind mental health conditions.
The researchers looked at the use of a device called a calibrated plastic drape — essentially a plastic bag with labels to identify levels of blood loss up to 500 milliliters, which is considered the baseline for postpartum hemorrhage. They concluded that using the device nearly doubled the rate of accurate detection of postpartum hemorrhage compared to estimating blood loss visually, as many health care providers do.
Providers who then delivered a bundle of treatments within 15 minutes based on the measurement — including a uterine massage, medications to induce contractions and stop bleeding, IV fluids and a physical exam — saw a 60% reduction in severe blood loss among patients relative to providers who administered the treatments one by one over a longer time.
Postpartum hemorrhage is a serious but rare condition characterized by heavy bleeding that causes a severe drop in blood pressure. It affects 1% to 5% of women who give birth, and people with blood clotting disorders face increased risk. An estimated 14 million women per year experience postpartum hemorrhages worldwide, resulting in about 70,000 deaths, according to the World Health Organization.
“Why is it that women are still dying? It’s because we aren’t picking up the cases and not treating them early enough,” said the new study’s lead author, Dr. Arri Coomarasamy, a professor at the University of Birmingham in the U.K.
“If you control the bleeding early, then you win, and if you don’t, then you are really fighting a losing battle,” he added.
That’s why the study’s proposed interventions “might be a game changer,” said Dr. Willibald Zeck, the chief of sexual and reproductive health and rights at the United Nations Population Fund, who was not involved in the trial.
The study involved more than 210,000 women across 80 hospitals in Kenya, Nigeria, South Africa and Tanzania. (About 70% of maternal deaths globally occurred in sub-Saharan Africa in 2020, according to a WHO report.) Among the participants, 17 patients treated with the proposed set of interventions died, compared to 28 who received standard care.
Traditionally, treatments for postpartum hemorrhage are delivered sequentially as providers assess what works, the new study noted. But Coomarasamy and his collaborators — who presented their findings at the International Maternal Newborn Health Conference in Cape Town — are pushing for the simultaneous delivery of various treatments to help save precious time.
“It doesn’t matter which one works in the end if what you want to do is stop the bleeding,” Coomarasamy said. “The clock is ticking and the woman is bleeding — that’s where the problem is, and that’s where the bundle makes a real difference.”
Widespread implementation of the proposed regimen would require governments — especially in low-income countries — to supply calibrated drapes and the components of the treatment bundle, including two kinds of drugs, along with trained personnel to administer them, the researchers said.
Some such efforts are already underway. The Bill and Melinda Gates Foundation, which funded the study, will pay for a year’s supply of calibrated drapes in the 80 hospitals that were part of the trial, the researchers said.
Allisyn Moran, the head of the WHO’s maternal health unit, who was also not involved in the trial, pointed out that the majority of providers in the study who delivered the proposed treatment regimen were midwives.
“It’s an opportunity for us to also think about how we really strengthen midwifery care and midwives in all different settings,” Moran said.
However, the study has some limits: It did not measure patients’ experiences of the care they received, nor did it include hospitals in high-income countries.
But the researchers said they expect the results to be generalizable to other countries, noting the persistence of postpartum hemorrhage as a cause of maternal death in the U.S.
A panel of independent experts is expected to review the study findings and determine whether the WHO should officially endorse the proposed interventions, a process that could take months.