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Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide. There are over 14 million cases of PPH every year, and approximately 125,000 of these end in death. The majority of these deaths occur in resource-constrained settings, with 1/2 occurring in sub-Saharan Africa and 1/3 in South Asia. Additionally, there are over 20 million women living with chronic illnesses (such as anemia) resulting from PPH. Tragically, a child is 10 times more likely to die before their second birthday if their mother dies from PPH.
PPH is defined as the loss of ≥500 mL of blood within 24 hours after the birth of a child. PPH arises due to complications when the placenta is normally delivered. The main cause of PPH is uterine atony, which accounts for up to 90% of cases. Additional causes include retained placenta, genital tract trauma and bleeding disorders.
PPH is largely manageable with access to adequate resources. However, in resource-constrained settings, PPH is much more devastating. The nearest referral hospital is often many hours away, while a woman can bleed to death within two hours. Additionally, screening of at-risk women for earlier referral is challenging since 2/3 of the women display no risk factors for PPH.
Students at Johns Hopkins University are developing a method for quick cessation of blood loss to manage PPH in resource-constrained settings. They have developed the Automatically-Deflating Air Postpartum Tamponade (ADAPT); the first air-inflated tamponade. The ADAPT is equipped with a custom designed balloon which is inserted into the uterus and inflated to provide uniform pressure along the uterine wall. Additionally, the ADAPT automatically releases pressure, which allows the uterus to contract to its normal state while maintaining pressure against the uterine walls. The ADAPT incorporates the safety and performance of devices used in the developed world, at a much lower cost.
The ADAPT buys time for transportation to a higher care facility so treatment can be administered. Furthermore, the ADAPT is compatible with all WHO-recommended practices.
Animal studies are ongoing, with promising initial results. The ADAPT will decrease the morbidity and mortality associated with PPH, reduce the demand for advanced medical care and preserve the reproductive capacity of young patients.