Postpartum hemorrhage (PPH) is defined as blood loss of 500 ml and above or 1,000 ml of blood within the first 24 hours following childbirth (1, 2). It is the most common cause of pre-mature mortality of women worldwide. PPH is dangerous and life-threatening and can also lead to long-lasting health effects, including severe anemia (3). According to the 2013 World Health Statistics, the maternal mortality rate in low income, lower middle income, upper middle income and high income groups were 410, 260, 53, and 14/100,000 live births, respectively (4). More than 50% of all maternal deaths worldwide occurred mainly in Asian (India, Pakistan, Afghanistan) and three African (Nigeria, Ethiopia, and the Democratic Republic of Congo) countries (5). Major causes of maternal deaths are similar across low income countries, often obstetric in origin, and generally follow obstructed labor with or without rupture, hypertensive disorders (mainly severe preeclampsia and eclampsia), infection and hemorrhage (mainly placenta previa/abruption, urine rapture and postpartum hemorrhage) (4, 6). It is estimated that 94% of births in Ethiopia occur at home and 10% of maternal deaths are attributed to PPH (7).
Uterine atony, or lack of effective contraction of the uterus, is the most common cause of PPH (3) followed by infection, subinvolution of the placental site, and inherited coagulation deficits (8-11). The majority of these fatal obstetric complications occur during labor and immediately after birth. In the low income countries, more than three-quarters of maternal deaths due to the direct obstetric causes occur during and after birth (4, 12, 13). Organized diagnosis and management of PPH, including administration of uterotonic agents (14), controlled cord traction, and uterine massage after delivery of the placenta, are required to avoid maternal death.
The high frequency of PPH in the developing world is due to the lack of diagnosis and management methods as well as medications used in the active management of the third stage. Lack of experienced caregivers who can manage PPH and lack of blood transfusion services, anesthetic services, and operating capabilities also play a role.
A well-defined stepwise approach is recommended for treatment of uterine atony, including drugs and mechanical interventions, followed by surgery as a last intervention (3, 15, 16). The first diagnosis of PPH is performed by observing the amount of blood loss and the patient’s clinical status. The amount of blood loss, the patient’s level of consciousness and vital signs are continually assessed. Photospectometry is the gold standard blood loss measurement technique due to its accuracy. However, this technique is complicated, costly and impractical. It cannot be applied at all levels of healthcare and is more suitable for clinical research (17-19). Weighed soaked swabs or drapes after delivery are also used for early detection of PPH (20). However, this method substantially increases the workload of physicians and may not be suitable in a busy hospital setting. Bakri balloon (21), arterial embolization (22) and absorbable sutures (23) are other methods used to manage and reduce PPH. However, most of the techniques are either expensive and complex to apply in low resources settings or are associated with complications.
Currently, in low resource settings blood loss during delivery is estimated manually through visual inspection. Visual estimation of blood loss is subjective and generally inaccurate. Studies have showed that, independent of the experience or skill level of physicians, visual estimation of PPH has a 25% - 89% error of measurement (18).
In this project digitalized postpartum hemorrhage management device (DPHMD) is proposed to collect and measure blood loss, monitor vital signs and estimate the amount of IV fluid required to manage PPH at early stage. The proposed method can be used as a decision support system for physicians especially in low resource settings where both the expertise and medical devices are in scarce.