Saving mothers' lives with a plastic sheet - People Fixing the World podcast, BBC World Service

Key Concepts

Postpartum Hemorrhage (PPH), Severe Postpartum Hemorrhage (blood loss > 1 liter), Uterotonics, Blood Loss Estimation, Visual Estimation (Macho Meter), Plastic Drape/Collection Device, Early Detection, Maternal Mortality, Preventable Deaths, Uterine Contraction.

Postpartum Hemorrhage (PPH) - A Major Global Issue

• Definition: Excessive bleeding after childbirth. Up to 500ml of blood loss is considered manageable, but anything over that is classified as PPH. Severe PPH is defined as blood loss exceeding 1 liter.
• Global Impact: Affects approximately 14 million women worldwide, with around 70,000 deaths annually.
• Disproportionate Impact: Primarily affects women in low- and middle-income countries, particularly in sub-Saharan Africa.
• Leading Cause of Maternal Death: PPH is the leading cause of maternal mortality globally.
• Preventability: A significant portion of PPH-related deaths are preventable.
• Contributing Factors in Developing Countries:
  • Inadequate number of healthcare workers per patient.
  • Poor nutritional status of women, including anemia and low iron levels due to multiple pregnancies.
  • Reduced uterine contraction effectiveness with increasing deliveries.

The Problem with Visual Estimation ("Macho Meter")

• Traditional Method: Historically, healthcare providers have relied on visual estimation to assess blood loss after delivery.
• Inaccuracy: Visual estimation is often inaccurate, with providers struggling to estimate blood loss volumes correctly.
• "Macho Meter": The term "macho meter" (eyes as a meter) is used to describe this subjective assessment method.
• Consequences: Inaccurate estimation can lead to delayed or inadequate intervention, potentially costing lives.

The Plastic Drape/Collection Device: A Game Changer

• Description: A plastic sheet with a cone-shaped funnel that collects blood after delivery. The device is calibrated to allow for accurate measurement of blood loss.
• Application: The blue part of the drape is placed under the woman's buttocks immediately after delivery, and the pouch is rolled out to collect blood for one hour.
• One-Hour Monitoring: The first hour after delivery is crucial for monitoring blood loss. If bleeding continues despite interventions, monitoring may be extended.
• Study Results: A study conducted in Kenya, South Africa, Tanzania, and Nigeria showed a 60% reduction in severe PPH (defined as 1 liter of blood loss, death, or the need for surgery) with the use of the drape. This was significantly higher than the anticipated 25% reduction.
• Mechanism: The drape doesn't prevent hemorrhage but enables early and accurate detection.

PPH Prevention and Management Protocol

• Uterotonics: Immediately after delivery (within 1 minute), a uterotonic drug is administered to contract the uterus and reduce bleeding.
• Blood Loss Measurement: Following uterotonic administration, blood loss is measured using the plastic drape.
• Intervention: The drape is used in conjunction with other interventions to manage PPH.

Cost and Implementation

• Cost: The drape costs approximately 200 Kenyan shillings (around $1.5 USD).
• Cost-Effectiveness: The cost is considered reasonable, especially when compared to the cost of managing severe PPH and its complications.
• Reusable Component: The part of the drape that goes under the buttocks can be reused up to 100 times after cleaning, further reducing costs.
• Funding and Support: The Gates Foundation provided funding to supply the drapes to participating facilities.
• Government Adoption: The Kenyan Ministry of Health has incorporated the use of the drape into national guidelines for PPH management.

The Emotional Impact of Preventable Maternal Deaths

• Joy and Sorrow: Obstetrics is described as a joyous field due to the experience of bringing new life into the world. However, maternal death represents the extreme opposite and is deeply painful.
• Preventability: Even when a death is deemed non-preventable at a tertiary hospital, it is often preventable at some point in the continuum of care.
• Motivation: The speaker expresses a strong commitment to finding solutions to prevent maternal deaths and improve maternal healthcare.

Conclusion

The plastic drape/collection device represents a simple yet highly effective solution for improving the early detection and management of postpartum hemorrhage. Its affordability, ease of use, and proven impact on reducing severe PPH have made it a valuable tool in improving maternal healthcare outcomes, particularly in resource-limited settings. The combination of this device with existing PPH prevention protocols, such as the administration of uterotonics, offers a comprehensive approach to reducing maternal mortality and ensuring safer childbirth experiences for women worldwide.