Future of Medical Devices in Postpartum Hemorrhage Intervention

Did you know that postpartum hemorrhage (PPH) is the leading cause of maternal death worldwide, responsible for 27% of the 295,000 maternal deaths that occur every year? And did you know that two‐thirds of these are due to situations of PPH? 

 

According to the Cleveland Clinic, PPH is defined as severe bleeding after giving birth, typically taking place within 24 hours of giving birth but can also occur after up to 12 weeks. Various factors can come into play, including in the instance when uterine contractions are not strong enough to stop bleeding that occurs during birth, which the Cleveland Clinic also reports as the cause of up to 80%. PPH does not discriminate: It can occur in instances of Cesarean or vaginal delivery (though Cesarean may be more common).

 

These stats are harrowing, and while traditional identification and treatment methods have been effective, there is certainly room to advance. With this, some exciting interventional medical devices and clinical solutions in fresh use or on the horizon could transform how medical professionals address instances of PPH and improve maternal outcomes. 

Not a new issue in maternal health, PPH has been a longstanding focus of the medical community as it continues to investigate and identify ways to best intervene and save lives. Currently, medical professionals tap into strategic and thoughtful methods of treatment that have made a real difference. Various effective methods of PPH intervention include: 

• Uterine compression sutures: These sutures bind and press the uterus to squeeze the blood vessels in the uterine wall, reducing the rapidity of blood flow. Additionally, with compression, ischemia in the uterus’s myometrium stimulates uterine contractions and makes the sinus close under pressure.

• Uterine massage: These massages are done on a woman’s abdomen after the placenta is delivered during childbirth and help push the uterus to continue contractions. PPH is a big risk as a placenta detaches from the uterine wall and bleeds, and the continuation of contractions is very important. Similarly, medication is also utilized to stimulate contractions.

• Retained placenta removal: Significant bleeding occurs when placenta tissue remains in the uterus after delivery, which should have fully separated during the childbirth process. If left untreated, the remaining pieces of the placenta could cause serious issues as it is considered the second leading cause of PPH. 

• Laparotomy: Laparotomy is a type of surgery that opens up a woman’s abdomen to determine the cause of the bleeding in the hopes of solving PPH at the source. This surgery provides medical professionals with a clear view of origination to help with intervention. 

• Hysterectomy: This procedure is the surgical removal of the uterus. Ideally, this would be a last resort procedure in treating PPH. 

While these tried-and-true methods have proven to be successful in quite a few cases of PPH, there is always room for improvement, and the medical community continues to look to new and inventive technologies to move the needle toward improved maternal health

The theme in new technologies and clinical solutions to support intervention of PPH is around seamlessness and fresh impact, creating devices and systems with the necessary tech power to be effective while also incorporating levels of unique monitoring, utilization of tiny devices, minimally invasive procedures and more. Examples include:

• Biodegradable hemostatic materials: These materials are designed to be placed over a wound in the uterus from which PPH is occurring. They enable quick hemostasis to reduce blood loss. While degradable hemostatic materials have been effective, some challenges remain that biodegradability will ideally resolve.

• Aortic occlusion: When the first line of PPH intervention is unsuccessful, aortic occlusion (or occlusion of large blood vessels) can assist in decreasing pelvic bleeding and allow for further intervention if required. Aortic occlusion devices (remarkably small) essentially shut off blood flow to the uterus and often stave off the need for blood transfusions or emergency hysterectomies.

• Minimally invasive surgery (MIS): When fully invasive surgery to address issues of PPH seems to be the only option, MIS solutions (such as laparoscopy, the Jada System, and arterial embolism) minimize risk and reduce the amount of patient recovery required, as well as provide better control over bleeding.

• AI and robotics: One of the most exciting developments in the intervention of PPH is the use of AI and robotic systems. AI specifically allows for the analysis of large quantities of patient data to identify risk factors, with robotics delivering an entirely new level of precision critical in treatment. 

• Blood loss monitoring: Monitoring systems are not new to the medical community; however, blood loss measurement monitoring systems are transforming the way PPH intervention is approached. They leverage real-time data to enable early detection so serious issues can be avoided (where possible).

• New medications: Medications are part of the traditional routes to PPH intervention and have been very effective in use (medications include oxytocin, misoprostol, methylergonovine maleate, carboprost tromethamine and dinoprostone). The medical community continues to innovate in the testing of new medications that will assist in PPH treatment that are even more effective and will also cover care gaps that may currently exist to help more patients and increase positive outcomes. 

As we’ve seen, technology knows no bounds. With the medical community’s continued commitment to identifying new and fresh ways to provide PPH intervention, maternal care is on a path to reduced deaths in the postpartum period. We have a long way to go – the stats shared are significant and will certainly not change overnight; however, with the industry’s ongoing dedication to research and development and in the identification of new ways to manage PPH, women on a global scale will have the opportunity to enjoy motherhood with less fear.