Skip to main content

Advertisement

SpringerLink
Log in

In Pursuit of Solving a Global Health Problem: Prototype Medical Device for Autotransfusing Life-Threatening Postpartum Hemorrhage in Resource-Limited Settings

  • Emerging and Pipeline Technologies in Ob/Gyn (M Levie, Section Editor)
  • Published:
Current Obstetrics and Gynecology Reports Aims and scope Submit manuscript

A Correction to this article was published on 09 August 2018

This article has been updated

Abstract

Purpose of Review

The purpose of the review is to provide an overview of innovative technologies being developed to prevent and treat postpartum hemorrhage in resource-limited settings and to discuss a promising new device designed specifically to address the lack of safe blood supplies in many areas of the world.

Recent Findings

There are several new technologies being used or tested to address the significant global health problem of postpartum hemorrhage, the leading cause of maternal morbidity and mortality worldwide. None of these new technologies have addressed the persistent lack of safe blood supplies in low resource settings which is an essential pillar of comprehensive emergency obstetric care. With this aim in mind, a prototype obstetrical medical device was designed with the capability to autotransfuse women suffering life-threatening postpartum hemorrhage in low resource settings.

Summary

Postpartum hemorrhage remains the leading cause of maternal morbidity worldwide and efforts are needed, more than ever, to achieve the Sustainable Development Goals of improving maternal mortality especially in resource-limited settings. Despite many effective new technologies such as the non-pneumatic anti-shock garment, improvised uterine balloon tamponade devices, and new drugs such as tranexamic acid, none has addressed the lack of safe blood supplies that are critical to treating PPH. A prototype medical device has been developed, and preliminary testing for functionality and filter function has been successful and shows great promise. Further testing is still needed and is ongoing in preparation for human clinical trials.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Change history

  • 09 August 2018

    The original version of this article contains an error in the spelling of an author’s last name. Originally, the name was spelled as Hananeh Esmailbeighi. Her last name should be spelled as Esmailbeigi.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. World Health Organization. (2012). Trends in maternal mortality 1990–2010, WHO, UNICEF, UNFPA, and The World Bank estimates. Retrieved from http://www.unfpa.org/public/home/publications/pid/10728.

  2. •• World Health Organization. WHO recommendations for the prevention and treatment of postpartum haemorrhage. Geneva: World Health Organization, 2012. Retrieved from http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/9789241548502/en/. This article gives the latest and most comprehensive guidelines for the prevention and treatment of postpartum hemorrhage to reduce the global burden on maternal mortality and helps shape clinical protocols and health policies.

  3. Fawole B, Awolude OA, Adeniji AO, Onafowokan O. WHO recommendations for the prevention of postpartum haemorrhage: RHL guideline (last revised: 1 May 2010). The WHO Reproductive Health Library; Geneva: World Health Organization.

  4. ACOG. Practice bulletin: clinical management guidelines for obstetrician-gynecologists number 76, October 2006: postpartum hemorrhage. Obstet Gynecol. 2006;108(4):1039–47.

    Article  Google Scholar 

  5. Creanga AA, Berg CJ, Syverson C, Seed K, Bruce FC, Callaghan WM. Pregnancy-related mortality in the United States, 2006-2010. Obstet Gynecol. 2015;125(1):5–12.

    Article  PubMed  Google Scholar 

  6. Callaghan WM, Kuklina EV, Berg CJ. Trends in postpartum hemorrhage: United States, 1994-2006. Am J Obstet Gynecol. 2010;202(4):353.e1–6.

    Article  Google Scholar 

  7. Khan KS, Wojdyla D, et al. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367(9516):1066–74.

    Article  PubMed  Google Scholar 

  8. • Bates I, Chapotera GK, et al. Maternal mortality in sub-Saharan Africa: the contribution of ineffective blood transfusion services. BJOG. 2008;115(11):1331–9. This article clearly documents the impact a lack of safe blood transfusion services has on maternal deaths in sub-Saharan Africa underscoring the need to find solutions to inadequate safe blood supplies in treating PPH in this region

    Article  PubMed  CAS  Google Scholar 

  9. WHO Blood Transfusion Safety. Department of Essential Health Technologies. 2006 Retrieved from http://www.who.int/bloodsafety/en/Blood_Transfusion_Safety.pdf

  10. • Schantz-Dunn J, Nawal M. The use of blood in obstetrics and gynecology in the developing world. Rev Obstet Gynecol. 2011;4(2):86–91. This article provides an overview of the lack of safe blood supplies in Obstetrics and Gynecology in developing countries and calls for developing innovative ways to address this global health problem including developing autologous transfusion methods that are suited to these practice settings

    PubMed  PubMed Central  Google Scholar 

  11. Lund TC, Hume H, et al. The blood supply of Sub-Saharan Africa: needs, challenges, and solutions. Transfus Apher Sci. 2013;49(3):416–21.

    Article  PubMed  Google Scholar 

  12. Mbanya D. Use of quality rapid diagnostic testing for safe blood transfusion in resource-limited settings. Clin Microbiol Infect. 2013;19(5):416–21.

    Article  PubMed  CAS  Google Scholar 

  13. Geller SE, Adams MG, Kelly PJ, Kodkany BS, Derman RJ. Postpartum hemorrhage in resource-poor settings. Int J Gynecol Obstet. 2006;92:202–11.

    Article  CAS  Google Scholar 

  14. Pileggi-Castro C, Nogueira-Pileggi V, et al. Non-pneumatic anti-shock garment for improving maternal survival following severe postpartum haemorrhage: a systematic review. Reprod Health. 2015;12:28.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Miller S, Bergel EF, et al. Non-pneumatic anti-shock garment (NASG), a first-aid device to decrease maternal mortality from obstetric hemorrhage: a cluster randomized trial. PLoS One. 2013;8(10):e76477.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  16. Downing J, El Ayadi A, et al. Cost-effectiveness of the non-pneumatic anti-shock garment (NASG): evidence from a cluster randomized controlled trial in Zambia and Zimbabwe. BMC Health Serv Res. 2015;15:37.

    Article  PubMed  PubMed Central  Google Scholar 

  17. El Ayadi AM, Butrick E, et al. Combined analysis of the non-pneumatic anti-shock garment on mortality from hypovolemic shock secondary to obstetric hemorrhage. BMC Pregnancy Childbirth. 2013;13:208.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kausar F, Morris JL, et al. Nurses in low resource settings save mothers’ lives with non-pneumatic anti-shock garment. MCN Am J Matern Child Nurs. 2012;37(5):308–16.

    Article  PubMed  Google Scholar 

  19. Miller S, Fathalla MM, et al. Obstetric hemorrhage and shock management: using the low technology non-pneumatic anti-shock garment in Nigerian and Egyptian tertiary care facilities. BMC Pregnancy Childbirth. 2010;10:64.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Jordan K, Butrick E, et al. Barriers and facilitators to scaling up the non-pneumatic anti-shock garment for treating obstetric hemorrhage: a qualitative study. PLoS One. 2016;11(3):e0150739.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  21. Miller S, Martin HB, Morris JL. Anti-shock garment in postpartum haemorrhage. Best Pract Res Clin Obstet Gynaecol. 2008;22(6):1057–74.

    Article  PubMed  Google Scholar 

  22. Burke TF, Ahn R, et al. A postpartum haemorrhage package with condom uterine balloon tamponade: a prospective multi-centre case series in Kenya, Sierra Leone, Senegal, and Nepal. BJOG. 2016;123(9):1532–40.

    Article  PubMed  CAS  Google Scholar 

  23. Pendleton AA, Natarajan A, et al. A qualitative assessment of the impact of a uterine balloon tamponade package on decisions regarding the role of emergency hysterectomy in women with uncontrolled postpartum haemorrhage in Kenya and Senegal. BMJ Open. 2016;6(1):e010083.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Natarajan A, Chavez J, et al. Provider experiences with uterine balloon tamponade for uncontrolled postpartum hemorrhage in health facilities in Kenya. Int J Gynaecol Obstet. 2015;131(2):201–4.

    Article  PubMed  Google Scholar 

  25. Natarajan A, Kamara J, et al. Provider experience of uterine balloon tamponade for the management of postpartum hemorrhage in Sierra Leone. Int J Gynaecol Obstet. 2016;134(1):83–6.

    Article  PubMed  Google Scholar 

  26. Nelson BD, Stoklosa H, et al. Use of uterine balloon tamponade for control of postpartum hemorrhage by community-based health providers in South Sudan. Int J Gynaecol Obstet. 2013;122(1):27–32.

    Article  PubMed  Google Scholar 

  27. Tindell K, Garfinkel R, et al. Uterine balloon tamponade for the treatment of postpartum haemorrhage in resource-poor settings: a systematic review. BJOG. 2013;120(1):5–14.

    Article  PubMed  CAS  Google Scholar 

  28. Rathore AM, Gupta S, et al. Uterine tamponade using condom catheter balloon in the management of non-traumatic postpartum hemorrhage. J Obstet Gynaecol Res. 2012;38(9):1162–7.

    Article  PubMed  Google Scholar 

  29. Rishard MR, Galgomuwa GV, Gunawardane K. Improvised condom catheter with a draining channel for management of atonic post partum haemorrhage. Ceylon Med J. 2013;58(3):124–5.

    Article  PubMed  CAS  Google Scholar 

  30. Maya ET, Buntugu KA, et al. Condom tamponade in the Management of Primary Postpartum Haemorrhage: a report of three cases in Ghana. Afr J Reprod Health. 2015;19(3):151–7.

    PubMed  Google Scholar 

  31. Thapa K, Malla B, et al. Intrauterine condom tamponade in management of post partum haemorrhage. J Nepal Health Res Counc. 2010;8(1):19–22.

    PubMed  CAS  Google Scholar 

  32. Shakur H, Elbourne D, et al. The WOMAN Trial (World Maternal Antifibrinolytic Trial): tranexamic acid for the treatment of postpartum haemorrhage: an international randomized, double blind placebo controlled trial. Trials. 2010;11:40.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  33. Akhter S, Anwar I, et al. Barriers to timely and safe blood transfusion for PPH patients: evidence from a qualitative study in Dhaka, Banglasdesh. PLoS One. 2016;11(12):e0167399.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  34. Osaro E, Charles AT. The challenges of meeting the blood transfusion requirements in sub-Saharan Africa: the need for the development of alternatives to allogenic blood. J Blood Med. 2011;2:7–21.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Nkwabong E, Takang WA, Kouam L. Simple technique for autologous transfusion in ruptured ectopic pregnancy: report of six cases managed at the Yaounde University Hospital in Cameroon. Med Sante Trop. 2016;26(1):75–7.

    PubMed  CAS  Google Scholar 

  36. Selo-Oieme DO. Intraoperative blood salvage and autotransfusion in the management of ruptured ectopic pregnancy: a review. East Afr Med J. 2001;78(9):465–7.

    Google Scholar 

  37. Shukla P, Dwivedi S, et al. Intraoperative autologous blood transfusion of peritoneal blood during laparotomy for ectopic pregnancy: prospective study. J Obstet Gynaecol India. 2014;64(5):358–61.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Takeda A, Manabe S, et al. Management of patients with ectopic pregnancy with massive hemoperitoneum by laproscopic surgery with intraoperative autologous blood transfusion. J Minim Invasive Gynecol. 2006;13(1):43–8.

    Article  PubMed  Google Scholar 

  39. Wong T, Sierzega K, Roytman G, Robinson N, Kutz P, Geller S, Dobiesz V, Esmailbeigi H. Design and development of a novel, low-cost, portable, autotransfusion device for application in low resource settings. Biomedical Engineering Society (BMES) meeting October 2015.

  40. Wong T, Sierzega K, Roytman G, Robinson N, Kutz P, Geller S, Dobiesz V, Esmailbeigi H. Design and development of a novel, low-cost, portable, autotransfusion device for application in low resource settings. BioMedWoman Conference in Portugal June 23, 2015.

  41. Collofello B, Robinson R, Dobiesz V, Kutz P, Koch A, Harrington A, Esmailbeigi H, Geller S. Assessing prototype filter function in eliminating fetal surrogate markers and bacterial load in and obstetrical medical device for autotransfusion in postpartum hemorrhage. Oral Presentation Consortium of Universities for Global Health (CUGH) San Francisco April 9, 2016.

  42. Collofello B, Robinson R, Dobiesz V, Kutz P, Koch A, Harrington A, Esmailbeigi H, Geller S. Testing the filter function of a prototype device to eliminate fetal surrogate markers and bacterial load for autotransfusion in postpartum haemorrhage in low-resource settings. Lancet Glob Health. 2016;4:S26.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Humanitarian Initiative, Harvard Medical School, 75 Francis Street, Neville House NH 226, Boston, MA, 02115, USA

    Valerie Dobiesz

  2. University of Illinois College of Medicine at Chicago, Chicago, IL, USA

    Gardner Yost & Brandon Collofello

  3. Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, Torrance, CA, USA

    Nuriya Robinson

  4. Division of Cardiothoracic Surgery, University of Illinois at Chicago, Chicago, IL, USA

    Pam Kutz-McClain

  5. Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA

    Hananeh Esmailbeighi

  6. Department of Pathology, Loyola University, Chicago, IL, USA

    Amanda Harrington

  7. Center for Research on Women and Gender University of Illinois at Chicago, Chicago, IL, USA

    Abigail Koch

  8. Department of Obstetrics and Gynecology, Center for Research on Women and Gender, University of Illinois at Chicago, Chicago, IL, USA

    Stacie Geller

Authors
  1. Valerie Dobiesz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gardner Yost
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nuriya Robinson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pam Kutz-McClain
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hananeh Esmailbeighi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Brandon Collofello
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Amanda Harrington
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Abigail Koch
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Stacie Geller
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Valerie Dobiesz.

Ethics declarations

Conflict of Interest

Valerie Dobiesz declares grant funding from the University of Illinois Chancellor’s Proof of Concept Grant and Discovery Grant and has a patent titled System and Method for Collecting and Autotransfusing Maternal Blood in Cases of Postpartum Hemorrage pending.

Gardner Yost, Nuriya Robinson, Pam Kutz-McClain, Hananeh Esmailbeighi, Brandon Collofello, Amanda Harrington, and Abby Koch declare that they have no conflicts of interest.

Stacie Geller declares a patent titled System and Method for Collecting and Autotransfusing Maternal Blood in Cases of Postpartum Hemorrage pending.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Emerging and Pipeline Technologies in Ob/Gyn

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dobiesz, V., Yost, G., Robinson, N. et al. In Pursuit of Solving a Global Health Problem: Prototype Medical Device for Autotransfusing Life-Threatening Postpartum Hemorrhage in Resource-Limited Settings. Curr Obstet Gynecol Rep 6, 182–188 (2017). https://doi.org/10.1007/s13669-017-0213-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13669-017-0213-3

Keywords

Search

Navigation