Tackling Postpartum Hemorrhage: Innovations on the Horizon

Postpartum hemorrhage (PPH) remains a significant global health concern as the leading cause of maternal mortality worldwide. According to the World Health Organization (WHO), each year, about 14 million women experience PPH resulting in about 70,000 maternal deaths globally ¹ . This condition, characterized by blood loss of 500 ml or more within 24 hours after birth ², can lead to severe morbidity and even mortality. Early detection, accurate measurement of blood loss and timely intervention are crucial for preventing severe outcomes. There has been a recent surge of innovation aimed at revolutionizing the field of obstetrics, removing the guess work for healthcare providers to predict, measure and manage PPH more effectively.

One of the most promising technologies for predicting PPH is predictive analytics augmented by the use of wearable devices. By analyzing vast amounts of patient data, including medical history, vital signs, and laboratory results, algorithms can identify patterns and risk factors associated with PPH. These predictive models can be used to stratify patients based on their likelihood of developing the condition, allowing for targeted interventions and closer monitoring. Augmenting the data capture through the use of wearable devices provides continuous monitoring that can provide valuable insights into a patient’s physiological status during and after childbirth. The ability to continuously monitor the patient’s condition, allowing the detection of subtle changes that may indicate impending PPH and the wearable devices can trigger early alerts to healthcare providers. Advancements in imaging technology are also playing a significant role in PPH prevention. Promising results have been published with an imaging device that can rapidly detect hemorrhage-driven peripheral vasoconstriction ³ as an early indication of PPH. By continuously monitoring with novel imaging techniques like this, early indicators of PPH can be effectively communicated to healthcare providers.

Historically, the most common method of measuring postpartum blood loss has been visual estimation, which is notoriously unreliable and prone to significant variability. This subjective approach can lead to underestimation of blood loss, delaying necessary interventions and increasing the risk of severe complications. To address these limitations, researchers and clinicians have explored a range of alternative methods that offer quantitative results with greater accuracy and objectivity. One promising development is the use of blood capturing drapes or pads. These pads incorporate specialized materials that allow for measurement through weight or volume as the blood loss is occurring. By placing the drape or pad beneath the mother during delivery, healthcare providers can obtain a quantitative estimate during the delivery allowing for volumetric measurement as the blood loss is occurring versus a retrospective measurement post-delivery.

Finally, innovation in managing PPH at early onset continues to be at the forefront of development with regards to PPH. One continued trend for managing PPH is the development of advanced uterotonics ⁴ along with step wise protocols for decision making and administration of these agents. In cases where the hemorrhage is more emergent or non-responsive to traditional compressions or advanced uterotonics, innovation remains at the forefront in devices that provide an alternative to uterine packing. Intrauterine vacuum devices represent a promising advancement in the management of PPH. These devices work by applying negative pressure to the uterine cavity, mechanically restoring uterine tone and promoting hemostasis. This approach offers several potential advantages over traditional methods by inducing rapid hemostasis, they are minimally invasive and have shown a high success rate. For example, one study reported a success rate of 94% in managing PPH ⁵.

Integrating more accurate and reliable methods for predicting, measuring and managing postpartum blood loss is a critical step towards improving maternal health outcomes worldwide. By early detection and timely intervention, PPH-related complications can be minimized, and maternal mortality rates can be reduced. As research continues to advance, it is likely that even more innovative techniques will emerge, further enhancing our ability to prevent and manage this devastating condition. Additionally, as technology continues to advance, we can expect to see even more innovative approaches to predicting and preventing postpartum hemorrhage.

References:

1. WHO postpartum haemorrhage (PPH) summit
2. First global call for data on postpartum haemorrhage (who.int)
3. Francesca Bonetta-Misteli, Toi Collins, Todd Pavek, Madison Carlgren, Derek Bashe, Antonina Frolova, Leonid Shmuylovich, and Christine M. O’Brien, “Development and evaluation of a wearable peripheral vascular compensation sensor in a swine model of hemorrhage,” Biomed. Opt. Express 14, 5338-5357 (2023)
4. Vogel JP, Williams M, Gallos I, Althabe F, Oladapo OT. WHO recommendations on uterotonics for postpartum haemorrhage prevention: what works, and which one? BMJ Glob Health. 2019 Apr 11;4(2):e001466. doi: 10.1136/bmjgh-2019-001466. PMID: 31139461; PMCID: PMC6509591.
5. Overton, Eve et al. Intrauterine devices in the management of postpartum hemorrhage. American Journal of Obstetrics & Gynecology, Volume 230, Issue 3, S1076 – S1088