An innovative plastic drape could save tens of thousands of women’s lives from excessive bleeding during childbirth, according to new research – and could be manufactured for less than a dollar.
A woman dies from postpartum haemorrhage somewhere in the world every 12 minutes. It is the leading cause of maternal death, killing almost 43,000 mothers every year and diagnoses are rising globally.
Yet many of these deaths do not need to happen because the tools to prevent them already exist, according to a new three-part series published in the influencial medical journal The Lancet. Among them is a low-cost plastic sheet that measures blood loss so that life-saving treatment can be triggered sooner.
“Women are bleeding, the blood goes into bedsheets and kidney dishes, or onto the floor,” said Adam Devall, Professor of Maternal Health Clinical Trials at the University of Oxford. “Commonly, even in high income settings, healthcare professionals are estimating this blood loss, but visual estimation is wildly inaccurate.”
If a plastic drape is put under the woman after she has given birth, the blood collects and is measured by warning lines. This allows for early detection of postpartum haemorrhage and vital early treatment of a condition that is a “race against time”, according to Devall.
Researchers carried out trials on more than 20,000 women across Nigeria, Kenya, Tanzania and South Africa. They found that the drape, when used alongside a specialised first response treatment bundle, led to a 60 per cent reduction in primary outcome in vaginal births, which means severe bleeding, death or surgery.
“In our wildest dreams when we planned the trial we thought we might get a 25 per cent in our primary outcome. When we got the results it was mindblowing,” said Devall.
“I have been doing clinical trials for almost 20 years now and I have never seen an effect size of this magnitude.”
The researchers found that previously, only 50 per cent of postpartum haemorrhages were being detected, but that rose to 90 per cent during the trial.
Detection is coupled with a trigger criteria – treatment was already administered to a woman if she was thought to have lost half a litre of blood. In the trial, interventions happened at 300ml when it occurred alongside abnormal clinical signs like changes to heart rate or breathing.
The treatment bundle, known as MOTIVE, means women receive five evidence-based interventions immediately after diagnosis, including uterine massage to encourage contractions, medication and IV fluids.
Sub-Saharan countries like Nigeria or the Democratic Republic of Congo have some of the worst outcomes for maternal mortality in the world. Dr. Hadiza Galdanci, a professor of obstetrics and gynecology at Bayero University in Nigeria, cared for her cousin during her fourth pregnancy.
“After she delivered, there was blood everywhere. I administered every single treatment I could think of … but she continued to bleed,” she told the Gates Foundation, who supported the trial. “I knew I had to do something, so we rushed her to the operating room for a hysterectomy and gave her six pints of blood.”
Now Aminu Kano Teaching Hospital, where Galdanci also works as an OB-GYN, has adopted the plastic drapes and treatment bundle.
“Before … clinicians would typically administer one intervention, wait to see if it worked, and, if not, try another, losing valuable time. Waiting can cost lives,” she said.
Mortality rates can be more than 200 times lower in well-resourced countries like the US, the research found, yet the findings are also being implemented closer to home. The drape was included in recent recommendations published in the NHS England’s Maternal Care Bundle.
Recent data shows UK maternal death rates are now about 20 per cent higher than they were 15 years ago. After trials, hospital trusts may implement the drape by 2027.
Steady progress had been made on maternal mortality rates globally since the 1990s, however it has now slowed and even reversed in some countries after sweeping cuts to international aid by US President Donald Trump and other countries, including the UK.
A key target of the cuts was family planning programs worldwide and The Independent reported on the deadly impact already playing out in countries like Uganda and Zimbabwe last year. Clinics are being forced to abandon their patients, and tens-of-thousands of women and girls could die.
The biggest barrier to rolling out the research findings is investment, but work is underway as the Gates Foundation partners with local companies in places like South Africa to develop the drape. They could be produced on a roll for easy deployment and cost less than a dollar each.
Next, researchers plan to tackle Caesarean sections, which make up about a quarter of births but account for around 40 per cent of maternal deaths. Tracking blood loss from surgery is much harder due to the presence of other fluids, such as amniotic fluid, but Devall believes early detection will also be the key. This article has been produced as part of The Independent’s Rethinking Global Aid project