The United Nations Children’s Fund (UNICEF) reports that more than 25% of the estimated 300,000 maternal deaths each year stem from postpartum hemorrhage, which is severe blood loss following childbirth. Most of these deaths occur in developing countries where access to quality medical facilities is limited. The United Nations (U.N.) states that postpartum hemorrhage is the leading cause of maternal mortality, claiming the lives of 130,000 new mothers each year. Technological advancements and innovations have introduced two significant medical devices to combat this issue and improve maternal health: the Non-pneumatic Anti-Shock Garment (NASG) and the Uterine Balloon Tamponade (UBT).

The Non-Pneumatic Anti-Shock Garment

NASGs resemble trousers and are divided into five to six segments. Each segment features Velcro straps that apply targeted pressure from the ankles to the abdomen, allowing for simultaneous vaginal treatments. Developed using technology similar to NASA’s anti-gravity suits, NASGs prevent unconsciousness by promoting blood circulation toward the head. They also reduce blood loss and increase survival chances in cases of postpartum hemorrhage by compressing the lower extremities to drive blood toward vital organs. This effective management ensures prolonged survival until medical help is available.

NASGs provide up to 48 hours of crucial support in emergencies and can be reused up to 144 times. Costing approximately $0.50 per use, NASGs are cost-effective and vital for maternal health. The World Health Organization (WHO), UNICEF and the United Nations Population Fund (UNFPA) recognize these garments as essential tools for reproductive, maternal, newborn and child health. Research indicates that NASGs can potentially reduce maternal deaths from postpartum hemorrhage by half in specialized care settings, highlighting their critical role in improving reproductive health outcomes.

The Uterine Balloon Tamponade

The UBT is a medical device used to manage postpartum hemorrhage. It works by inserting a balloon into the uterus and inflating it with saline or sterile water using a syringe or gravity bag. This inflation applies pressure to the uterine walls, effectively controlling excessive bleeding. Although UBTs are effective, they are expensive, with costs ranging from $125 to $350 per use, limiting their use primarily to high-income countries as a surgical intervention for severe postpartum hemorrhage.

In areas without adequate medical facilities, health practitioners have improvised with makeshift versions of the UBT. UNICEF reports the use of condoms, inserted into the uterus and inflated with saline through a catheter, as an emergency alternative to UBTs. These ad-hoc solutions can mitigate blood loss but pose significant safety risks. A 2019 study in Ivory Coast confirmed the effectiveness of UBTs, successfully managing postpartum hemorrhage in nearly all treated cases, highlighting the need for both proper medical oversight when using such devices and further innovations in Maternal Health.

The Adoption of NASG and UBT Devices

Despite the clinical proof of its effectiveness, the NASG faces several challenges that limit its wider use. A general lack of awareness about the importance of NASG exists. Additionally, many health facilities report shortages due to the device’s high initial cost. Additionally, gaps in knowledge about the proper use and maintenance of NASGs further complicate efforts to implement them effectively.

Similar to the NASG, despite its effectiveness in controlling postpartum hemorrhage, UBT is expensive, challenging its widespread use in low- and middle-income countries. The WHO restricts UBT approval to environments where advanced treatments like blood transfusions and surgeries are available. Clinical trials reported in Obstetrics and Gynecology journals have highlighted potential risks of using UBT-like devices in remote settings, including instances where the intervention might have worsened blood loss. Trained medical personnel are advised to use such devices with caution, particularly in less-equipped environments.

Moving Forward

The U.N. agency is collaborating with governments and hosting online seminars. The aim is to promote the effectiveness of the NASG in reducing postpartum hemorrhage. Since 2019, UNICEF has included the NASG in its Supply Catalogue for global accessibility. Additionally, UNICEF is searching for cost-effective alternatives to the UBT. UNICEF has identified a manufacturer that offers the device at $5-15 per usage. More than 10 countries now recognize this affordable UBT as an essential medical product, with at least 16,000 units purchased. Concurrently, WHO is launching a study in Vietnam to test procedures, including a UBT-like device, to mitigate postpartum hemorrhage and improve maternal health. This research aims to address previous concerns about the UBT’s risks and develop more innovations to reduce maternal deaths and improve maternal health.

– Naomi Finapiri

Naomi is based in London, UK and focuses on Technology and Solutions, Global Health and Celebs for The Borgen Project.

Photo: Flickr