A novel obstetric medical device designed for autotransfusion of blood in life threatening postpartum haemorrhage

Abstract

Postpartum haemorrhage (PPH) is an obstetric emergency caused by excessive blood loss after delivery, which is the leading cause of maternal mortality worldwide. PPH can lead to volume depletion, hypovolemic shock, anaemia and ultimately death. The prevalence of PPH is disproportionately higher in low resource settings where there is limited access to skilled medical care and safe blood supplies. Current management strategies target both prevention and treatment of PPH however no alternatives currently exist to address the lack of safe blood supplies which are considered essential in emergency obstetrical care. Autotransfusion is used to salvage blood loss in a variety of clinical settings but has never been used in the context of vaginal delivery. We describe the development and testing of a novel device for the collection, filtration and autotransfusion of blood lost due to PPH. The prototype device is inexpensive and easily operated so that it may be practically deployed in low resource settings. The device is comprised of a blood collection drape, a pump apparatus, three leukocyte reduction filters and a reservoir for filtered blood. Preliminary testing demonstrates efficacy of microbial load reduction of up to 97.3%. To reduce cost and improve safety, the device is modular in design such that the drape, tubing, filters and transfusion bag may be stored sterile, used once and discarded; while the pump apparatus may be used indefinitely without the need for sterilisation. Preliminary results indicate the device confers a low cost and potentially effective means of collecting, pumping, filtering and returning blood to a patient following PPH in settings that lack safe blood supplies. This device shows promise as a method of stabilising patients suffering of PPH in low resource settings until definitive treatment is rendered with the ultimate goal of reducing maternal mortality globally.

Intrauterine balloon tamponade for postpartum hemorrhage

“…The included studies were also classified according to the allocation concealment defined by the Cochrane Selection bias 1 Performance bias 2 Viés de detecção 3 Detection bias 4 Reporting bias 5 ? ?…”

“…Postpartum hemorrhage is defined as an obstetric emergency caused by excessive and/or cumulative blood loss (greater than 1,000 mL) within 24 hours (primary or early) or after this period (secondary) due to uterine atony or failure of the uterus to contract and retract after the child is born, regardless of the mode of delivery, resulting in signs and symptoms of hypovolemia and hemorrhagic shock. [1][2][3][4] This condition is one of the most common complications in clinical obstetric practice, notably in its most severe form (hemorrhage > 1,500 mL), accounting for about 30% of maternal deaths. It requires immediate recognition and management to avoid significant morbidity and mortality.…”

Autotransfusion in low-resource settings: a scoping review

“…Emphasis on AT was assessed and sorted as: main theme (8 records), [28][29][30][31][32][33][34][35] section (6 records) 18 36-40 or mentioned (24 records) (online supplemental file 4).…”

“…Only one journal article specifically studied the clinical use of AT in an LRS. 29 The remaining research articles either reported on the development of an AT device for use in an LRS [30][31][32][33][34] or did not have AT as their main theme. 36-38 41-47 AT in LRS continues to be thought of, reported as, or portrayed as a safe 26 28 29 41 and life-saving technique.…”

The blood deserts of Bihar and implications for postpartum hemorrhage care

“…IAT is another technology that can provide life-saving blood in emergent situations no available blood. 5 Handheld, portable, and reusable IAT devices have recently been designed for low-resource environments without a stable blood supply. 5 This process aids in stabilizing patients until definitive treatment can be administered, necessitating proper training for healthcare providers to implement this technique in the delivery room.…”