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MacArthur Grant Funds Innovative UCSF Project to Reduce Maternal Mortality
By Hadley Leggett An estimated 529,000 women die each year during pregnancy and childbirth, and more than 99 percent of these deaths occur in developing countries. Tragically, most of these deaths could be prevented with prompt emergency care, but in resource-poor areas, long delays in accessing health care frequently cost women their lives. UCSF researchers at the Women’s Global Health Imperative have been working on an innovative program of low-cost interventions to treat obstetric hemorrhage in developing countries. Last month, the project took a giant leap forward when the MacArthur Foundation pledged $10.75 million to Pathfinder International, the non-governmental organization that is implementing the UCSF program in Nigeria and India. Obstetric hemorrhage, or excessive blood loss related to pregnancy or childbirth, accounts for roughly half of all maternal deaths. The most common cause is post-partum hemorrhage, caused by failure of the uterine muscles to contract after they have been stretched and exhausted during childbirth. Unless quickly controlled, the resulting blood loss can lead to shock and death within hours. In the United States, post-partum hemorrhage is rarely deadly; however, in the developing world, high-level medical facilities are scarce, and transportation can be hard to find. To curb blood loss en route to the hospital, UCSF associate professor Suellen Miller proposed using a novel first-aid device called the non-pneumatic anti-shock garment (NASG), originally designed by NASA in the 1970s. Made of stretchy, lightweight neoprene and resembling the bottom half of a wet suit, the garment applies pressure to the lower limbs, pelvis and abdomen via its five Velcro closures. During shock, blood normally pools in the lower half of the body; by applying up to 40 mmHg of circumferential pressure, the NASG helps shunt blood back to the organs that need it most: the brain, heart and lungs. Unlike traditional inflatable anti-shock garments, which require a complicated system of valves and pressure gauges, the NASG is fairly simple and easy to use. Training on how to apply the garment can be accomplished in about an hour, and each garment costs only $160 and can be reused up to 50 times. Even more importantly, the NASG appears to be safer than traditional anti-shock garments. Because the NASG uses lower pressure, it does not cause compartment syndrome or ischemia. Miller states, “In our various pilot studies in Nigeria and Egypt with approximately 600 women treated with the NASG, we have not had any women experience adverse events related to the NASG use.” One such pilot study, published in the April 2006 issue of the British Journal of Obstetrics and Gynecology, compared 158 women given standard treatment for obstetric hemorrhage with 208 women who received standard treatment plus the anti-shock garment. Results demonstrated a statistically significant 50 percent decrease in blood loss among those treated with the NASG. Larger studies will be needed to prove a statistically significant reduction in morbidity and mortality, and Miller and her colleagues are continuing to test the garment in randomized cluster trials in Zambia and Zimbabwe. Meanwhile, the MacArthur grant will enable Pathfinder International to provide anti-shock garments to several hundred health care facilities in India and Nigeria. In addition, the grant will supply several other proven interventions to stop post-partum hemorrhage, including medicines to contract the uterus and a calibrated device to measure blood loss. UCSF researchers will continue to advise the group on how to measure and document project outcomes. “It is tremendously gratifying to see this work being expanded by Pathfinder,” said Miller in a recent UCSF news release. “Hundreds of thousands of new mothers die needlessly every year due to hemorrhaging…. This simple garment appears extremely promising in pilot studies and could potentially have a huge impact on the lives of both the women and their families.”
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