It is a known fact that despite advancements in maternal care and medical technology, women continue to lose their lives across the world due to reasons concerning pregnancy and childbirth.
Most of these deaths occur in areas that have a deficit or lack of access to resources. Postpartum haemorrhage (PPH) is considered one of the primary causes of maternal deaths. So how does one save lives? Researchers from Massachusetts General Hospital say that a method to control haemorrhage during childbirth that has been around since the early 1980s is highly effective in arresting blood loss: Uterine balloon tamponade (UBT).
What is UBT?
A balloon is slid inside the cervix using a catheter. Then, the balloon is inflated with water. It fills the uterine cavity completely. This aids in the arresting of haemorrhage.
A rigorous study
In the past, two studies have explored the effectiveness of UBT in tackling PPH—one in 2013 and the other in 2019. According to Thomas Burke, lead author of the paper, this new study "really puts a nail in that coffin."
According to Burke, the pitfall of the two earlier studies were that they generated much "confusion and controversy" around UBT. The researchers carried out a systematic evaluation and meta-analysis of 91 trials. Some were randomized control trials, some were non-randomized studies, while others were case series. What they found was that the overall success rate of UBT was 85.9 percent.
"We decided to take an extremely rigorous approach, bringing together all of the world's literature on this technique and inviting independent investigators to join. It was a massive project," said Burke, in a statement.
Effectiveness of the method
According to the author of the study, it is "exquisitely clear" that there has been a remarkable reduction in the maternal mortality rates in many parts of the world when UBT is used. While he stressed that they have saved lives, the unavailability or non-use has costed lives as well.
He adds that in certain parts of the world, nearly one in six women lose their lives due to pregnancy-related causes. "It's an embarrassment to humankind," he remarks.
Challenges of UBT and existing methods
Burke pointed out that the earlier trials were challenged not by the effectiveness of the method, but the implementation of the program. He adds that the implementation of a method extends beyond the sheer availability of it to medical practitioners. Integrating it into the health care system and effective usage is the key highlights.
"There's no question the device works fine. But saving a life is much more complex than just handing someone a device that's new to their practice. We need to study how to integrate the device into a health system so that good uptake, appropriate use, and best practice result in quality care."
As far as advanced methods are concerned, there are various methods such as emergency hysterectomy, ligation or embolization of the uterine artery, and a particular form of suturing. However, their implementation requires or high-tech equipment and extensive training. Also, not all hospitals across the world have access to them.
Maternal mortality across the world
According to the World Health Organization (WHO), nearly 810 women died of preventable causes related to pregnancy and childbirth in 2017. Most of the deaths,94 percent, occur in countries of low and lower-middle-income.
Maternal Mortality rates (MMR) in 2017 in low-income countries was 462 per 100,000 live births. This is a stark contrast to in high-income countries, where the MMR was just 11 per 100,000 live births.
The countries that were considered to be a 'very high alert' or 'high alert' fragile state in 2017 were: Afghanistan, Central African Republic, Chad, Ethiopia, Guinea, Haiti, Iraq, Nigeria, Somalia, Sudan, South Sudan, Syria, the Democratic Republic of the Congo, Yemen, and Zimbabwe.
