Postpartum haemorrhage: Trying to save moms and infants

The 33-year-old trader and mother of three kids is Mrs. Aisha Al-Hassan. Her family and business are the centre of her existence.

Unfortunately, complications from a postpartum haemorrhage that occurred after the birth of her fourth child caused her death.

Al-Hassan, sadly, is one of the 14% of Nigerian women who have passed away from a maternal cause.

Postpartum haemorrhage (PPH), according to the World Health Organisation, is the loss of more than half a litre of blood within 24 hours of childbirth.

Every year, PPH affects 14 million women, kills 70,000 of them, mostly in low-income nations, and leaves those who survive with long-term, incapacitating problems like heart or kidney failure.

Postpartum haemorrhage is frequently brought on by anaemia, which is a severe iron deficit. Around the world, up to 37% of pregnant women suffer from anaemia.

According to research demonstrating that Nigeria has the highest rate of maternal mortality worldwide, postpartum haemorrhage is the leading cause of maternal deaths, according to Dr. Hadiza Galadanci, professor of obstetrics and gynaecology at Bayero University Kano’s College of Health Sciences.

The diagnosis of PPH, according to Galadanci, has a serious fault since medical professionals frequently struggle to determine when a patient has lost too much blood.

They simply have a crude visual assessment as a tool, she said.

In a study they termed E-MOTIVE, Galadanci and a group of researchers in four African nations with significant maternal mortality found that almost half of the women with PPH never received any kind of diagnosis.

Galadanci stated this at the Bill and Melinda Gates Foundation Goalkeepers Conference that was held in conjunction with the 78th United Nations General Assembly (UNGA) meeting in New York. “Therefore, they never got lifesaving treatment,” Galadanci remarked.

When PPH was discovered, the professor continued, medical professionals used a combination of five different treatments to stop the bleeding: uterine massage, oxytocic medications, tranexamic acid, IV fluids, and genital-tract examination.

But those therapies were being given in a very slow, sequential manner.

“We thought, why don’t we combine the interventions and provide all five at once. We gave it a try, and the amount of bleeding cases dropped by 60%, she stated.

The Gates Foundation dedicated its 2023 Goalkeepers Conference to highlighting the need for urgent action to accelerate the United Nations Sustainable Development Goals (UN-SDGs) and reduce maternal and child mortality because it was concerned about the slowing progress towards achieving the Sustainable Development Goals for the survival of mothers or babies.

The goal of accelerating the drop in maternal mortality by 2030 has gained support from all nations. “Reducing the global maternal mortality rate (MMR) to less than 70 per 100, 000 births, with no country having a maternal mortality rate that is more than twice the global average,” is one of the lofty goals of SDG 3 on good health and wellbeing.

The global MMR in 2020 was 223 per 100,000 live births; in order to reduce the global MMR to 70 or lower by the year 2030, a reduction rate of 11.6% annually will be needed, which has rarely been accomplished at the national level.

Investment in women’s healthcare, particularly in high quality, affordable, and equitable healthcare, according to Melinda French-Gates, Co-Chair, Bill and Melinda Gates Foundation, is a surefire approach to create the better future that we have always dreamed of.

She claims that there is a growing health gap and dwindling opportunities for women around the world.

“Maternal mortality is mostly avoidable, but regrettably, 800 women lose their lives during childbirth every day.

According to statistics, a woman’s death is most likely to occur on the day she gives birth.

She claims that the organisation has helped bright experts create novel strategies that can guarantee that more women have access to life-saving care.

highlighting the fact that their study is creating new, inexpensive, and portable pathways for treating and preventing life-threatening delivery problems.

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

Prof. Bosede Afolabi, Professor of Obstetrics and Gynaecology, College of Medicine University of Lagos, commented on innovations affecting maternal health. He said anaemia was not only a cause of postpartum haemorrhage but also an effect, one that could have long-term repercussions ranging from heart disease to depression.

Noting that anaemic women cannot withstand the same amount of blood loss as nonanemic women, she went on to explain that a woman with severe anaemia was much more likely to haemorrhage profusely during her delivery.

Afolabi introduced a one-time, 15-minute intravenous (IV) infusion of iron solution to help anaemic women in Nigeria and elsewhere (an IV drip that can replace women’s iron reserves during pregnancy—or even beyond pregnancy—and could aid in the speedy and effective treatment of severe instances of anaemia).

According to Afolabi, “this solution could mean not only saving women’s lives but also assisting them in leading better ones.”

A micronutrient supplement that tackles malnutrition was also unveiled; it was noted that a malnourished mother leads to a malnourished child.

More than a billion women and children worldwide, according to Afolabi, lack access to a nutritious diet and enough nutrition. Richer countries have easy access to supplements and vitamins as conventional treatments.

Afolabi added that Multiple Micronutrient Supplements (MMS) are interventions that could help millions of pregnant women, but low-income countries do not have access to such programmes.

“They are simple to use, inexpensive, and scaleable; they contain 15 vital minerals and vitamins, including folic acid and iron. And most importantly, they function.

“According to recent studies, MMS considerably lowers the chance of low birth weight by 12% and very low birth weight by 22%, both of which are now contributing factors in newborn deaths.

“In the modern world, we advise women to take folic acid and iron, which are only two nutrients and are poorly tolerated and frequently wasted.

“Researchers are putting a lot of effort into providing this support to all pregnant women in my country, Nigeria, as well as other nations, such as Pakistan and Ethiopia.

The long-overlooked problem of malnutrition in communities is finally being addressed, she said, and these supplements “represent more than just help; they also represent hope.”

Afolabi also revealed a hand-held portable AI-enabled ultrasound device that evaluates pregnancy, highlighting its affordability, usability, potential for earlier diagnosis and treatment, and low danger to women and babies.

“It’s encouraging to know that there are additional tools being researched and tested that can help to protect mothers during childbirth. That’s the world I’m excited about, and mothers deserve it, said Afolabi.

In a similar vein, Bill Gates, Co-Chair, Gates Foundation, claimed that more lives would only be saved if all moms and babies had access to the advances highlighted as well as high-quality medical services.

Gates highlighted that there were 4.6 million under-five infant deaths worldwide, stating that 2.2 million of those deaths occurred before the age of one month, 1.7 million occurred a week after birth, and 1 million occurred the day of birth.

Lamenting that little was known about the causes of neonatal deaths within the first 30 days of life, the foundation launched Child Health and Mortality Prevention Surveillance (CHAMPS), a programme that collects blood and tissue samples from deceased children in order to learn more about the fundamental causes of child mortality.

Gates admitted that the field of child health had advanced more quickly and significantly during the last ten years than he had anticipated in his lifetime.

In order to ensure that more children survive the vulnerable stages of pregnancy and the first two weeks, Gates said, “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.”

Gates emphasised the need for political will, legislative changes, and increased investment in women’s health and healthcare professionals, such as midwives, in order to ensure that mothers and babies have access to the treatment they need to live long and healthy lives.

Midwives are also the foundation of maternity and child healthcare in many communities around the world, according to Eva Nangalo, a midwife from Uganda.

Nangalo attributed the lack of power, equipment, necessary medications, and transportation to the deaths of women and infants in Uganda.

She urged the supply of contemporary technology, facilities, and medications to save mothers’ and babies’ lives around the world, as well as the engagement of midwives in policymaking that touches on maternal and neonatal health.

Mark Suzman, Chief Executive Officer of the Gates Foundation, stressed that while attempts were being made to scale up the innovations, it was ultimately the role of the international, regional, and national health authorities to incorporate the innovations into health systems.

According to Suzman, the cost of servicing debt exceeds the cost of healthcare in more than 50 countries.

“If you don’t invest in core human development – health and education – you can’t achieve health outcomes or save over 800 women who die daily from preventable maternal deaths,” he said.

He emphasised that the ideas described are practical, implementable steps that are inexpensive, save lives, and may be quickly implemented. He said that Goalkeepers was about potential, accountability, hope, and pledges.

Yes, we are falling behind on the SDGs, and it’s a challenging halfway point, but if we act now, we can achieve those targets by 2030, he said.

According to the News Agency of Nigeria (NAN), the Bill and Melinda Gates Foundation’s Goalkeepers programme aims to inspire and motivate thinkers and doers to work towards attaining the 17 Global Goals for Sustainable Development.

These goals, which were adopted by all United Nations members, serve as an ambitious plan for creating a better future for all by the year 2030.