Postpartum hemorrhage: On a quest to save mothers, babies

Mrs Aisha Al-Hassan is a 33-year-old trader and mother of three children. Her life revolves around her family and business.

Unfortunately, she died from postpartum hemorrhage complications that arose after delivery of her fourth baby.

Sadly, Al-Hassan is among 14 per cent of Nigerian women who had died as a result of maternal death.

According to the World Health Organisation, postpartum hemorrhage (PPH) is losing more than half a litre of blood within 24 hours of childbirth.

PPH affects 14 million women every year—killing 70,000 of them, primarily in low-income countries; and those who survive often face long-term, disabling complications, such as heart or kidney failure.

A common cause of postpartum hemorrhage is anaemia, or severe iron deficiency. Anaemia affects as many as 37 per cent of pregnant women around the world.

Dr Hadiza Galadanci, Professor of Obstetrics and Gynecology, College of Health Sciences, Bayero University Kano, said Postpartum hemorrhage was the number one cause of maternal death, with data showing that Nigeria has the highest maternal deaths globally.

Galadanci explained that there was a critical flaw in the way PPH was diagnosed, noting that healthcare workers often have a hard time recognising how much blood loss was too much blood loss.

“The only tool they have is a rough visual estimate,” she said.

Galadanci and a team of researchers in four African countries with high maternal mortality in a study they called E-MOTIVE, discovered that about half of the women who experience PPH were never diagnosed at all.

“Therefore, they never got lifesaving treatment,” Galadanci said at the Bill and Melinda Gates Foundation Goalkeepers Conference held on the sidelines of the 78th United Nations General Assembly (UNGA) meeting in New York.

The professor added that when PPH was identified, healthcare workers relied on a series of five treatments to stop the bleeding: uterine massage, oxytocic drugs, tranexamic acid, IV fluids, and genital-tract examination.

“But those interventions were being delivered sequentially—and far too slowly.

“We asked ourselves, why don’t we bundle the interventions together, administering all five at once. We tried it and we decreased cases of bleeding by 60 per cent,”she said.

Concerned by the slowing improvement to reach the Sustainable Development Goals for the survival of mothers or babies, Gates Foundation dedicated its 2023 Goalkeepers Conference to spotlight the need for urgent action to accelerate the United Nations Sustainable Development Goals (UN-SDGs) and reduce maternal and child mortality.

Countries have united behind the target to accelerate the decline of maternal mortality by 2030. SDG 3- Good health and wellbeing includes an ambitious target: “reducing the global maternal mortality rate (MMR) to less than 70 per 100, 000 births, with no country having a maternal mortality rate of more than twice the global average”.

The global MMR in 2020 was 223 per 100, 000 live births; achieving a global MMR below 70 by the year 2030 will require an annual rate of reduction of 11.6 per cent, a rate that has rarely been achieved at the national level.

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Melinda French-Gates, Co-chair, Bill and Melinda Gates Foundation, says investing in women’s healthcare, particularly in high quality, affordable, equitable healthcare was a sure way to build a better future we all imagined.

According to her, there is a widening health gap and declining prospects for women globally.

“Maternal mortality is highly preventable, but sadly 800 women die from childbirth daily.

“Statistically, the day a woman gives birth is the most likely day she is to die,” she said.

According to her, brilliant researchers supported by the foundation have developed new interventions that can ensure more women have access to lifesaving care.

Noting that their work is opening up new, low-cost and mobile—avenues of preventing and treating deadly childbirth complications.

“When combined with better primary health care and more resilient health systems, these innovations have the potential to save thousands of mothers’ lives in LMICs around the world by 2030,” she said.

On innovations that are shaping maternal health, Prof. Bosede Afolabi, Professor of Obstetrics and Gynecology, College of Medicine University of Lagos, said anaemia wasn’t just a cause of postpartum hemorrhage but also an effect—one that could lead to long-term consequences ranging from heart disease to depression.

Explaining that a woman with severe anaemia was much more likely to bleed heavily during her delivery, noting that an anaemic women cannot survive the same volume of blood loss as nonanemic women.

Afolabi unveiled a one-time, 15-minute intravenous (IV) infusion of iron solution to assist anaemic women in Nigeria and beyond (an IV drip that can replenish women’s iron reserves during pregnancy—or even after pregnancy—and it could help treat severe cases of anaemia quickly and effectively.)

“This solution could mean not just saving women’s lives but also helping them lead better ones,” Afolabi said.

Unveiled also was a micronutrient supplement that fights malnutrition, noting that a malnourished mother translates to a malnourished child.

According to Afolabi, globally, more than one billion women and children lack access to good nutrition and healthy diets, with supplements and vitamins as common solutions that’s readily accessible in wealthy nations.

In contrast, Afolabi said that low-income countries lack access to such interventions, adding that Multiple Micronutrient Supplements (MMS) are interventions that could assist millions of pregnant women.

“They contain 15 essential minerals and vitamins including folic acid and iron; easy to use, low-cost and ready to scale. Most importantly, they work.

“In current studies, MMS significantly reduces the risk of low-birth weight by 12 per cent and very low-birth weight by 22 per cent, both of which are factors in infant deaths today.

“In today’s world, we tell women to take folic acid and iron, which are poorly tolerated and often thrown away and address only two nutrients.

“In my country- Nigeria and others, including Pakistan and Ethiopia, researchers are working hard to bring this support to all pregnant women.

“These supplements represent more than just help; it also represents hope because a solution is finally being tailored to solve malnutrition in communities that were overlooked for far too long,” she said.

Afolabi also unveiled a hand-held portable AI-enabled ultrasound machine that assesses pregnancy, noting that it’s cheaper, convenient to use and could mean more timely diagnostic and interventions and few risks to newborn and mothers.

“It’s inspiring to see more tools in research and testing that could have an impact in keeping mothers safe during childbirth. That’s the world that excites me and a world mothers deserve,” Afolabi said.

Similarly, Bill Gates, Co-chair, Gates Foundation, said more lives would be saved only if all mothers and babies have access to both quality health care services and the innovations spotlighted.

Gates noted that global under five-years child deaths was 4.6 million children, explaining that 2.2 million children die before they are one month old; 1.7 million die a week after birth, while one million children die the same day of birth.

Lamenting that there was little knowledge of the cause of neonatal deaths in the first 30 days of life, which made the foundation to establish Child Health and Mortality Prevention Surveillance (CHAMPS- an initiative of the foundation started in 2015 to learn more about the root causes of child death by taking blood and tissue samples from children who died.)

Gates acknowledged that over the past decade, the field of child health had moved faster and farther than he thought he would witness in his lifetime.

“We need to make the effort to take this knowledge and low-cost tools and do our best to get them out into the world so that in those fragile times of pregnancy and first two weeks that more kids grow up to live healthy and productive lives,” Gates said.

Gates, therefore, stressed that providing access to quality health care for mothers and babies to live long and healthy lives requires policy changes, political will, and more investment in women’s health and health care workers, including midwives.

Furthermore, Eva Nangalo, a midwife from Uganda, said that midwives are the backbone of maternal and child healthcare in many communities around the world.

Nangalo attributed the deaths of mothers and babies in Uganda to shortage of power, lack of equipment, absence of essential medicines and lack of transportation.

She called for inclusion of midwives in policymaking that borders on maternal and neonatal health, provision of modern equipment, facilities and medicines to save the lives of mothers and babies globally.

On efforts to scale up the innovations, Mark Suzman, Chief Executive Officer, Gates Foundation, emphasised it was ultimately the responsibility of the global, regional and national health authorities to integrate the innovations into health systems.

Suzman said that more than 50 countries are paying more in debt servicing than in health.

“You can’t achieve health outcomes or save over 800 women who die daily from preventable maternal deaths if you aren’t allocating into core human development – health and education,” he said.

He noted that Goalkeepers was about possibility, accountability, hope and commitments, stressing that the outlined innovations are concrete, implementable actions which are low-cost, save lives and could be rolled out fast.

“Yes, we are behind in the SDGs and it’s a tough half-time, but we can meet those goals by 2030, if we take actions now,” he said.

The News Agency of Nigeria (NAN) reports that the Goalkeepers initiative led by the Bill and Melinda Gates Foundation, is designed to inspire and incentivise thinkers and doers toward achieving the 17 Global Goals for Sustainable Development.

These Goals form an ambitious blueprint for reimagining a better future for all by 2030 and were agreed upon by all member states of the United Nations.

(NAN]