Recognizing Postpartum Hemorrhage
Some blood loss is a natural part of childbirth. However, losing too much blood is harmful to mothers, especially those in the developing world where a mother may be anemic at the beginning of pregnancy. In these countries, anemia (a risk factor for postpartum hemorrhage) is much more prevalent and access to treatment is often limited. In the US, mothers rarely die from postpartum hemorrhage (PPH). In developing nations, PPH frequently causes preventable maternal deaths. Treating PPH hinges first and foremost on recognizing its occurrence. The ability to recognize and then immediately seek care can help decrease maternal mortality.
Visual estimation of blood loss has not been shown to be accurate. Multiple studies have concluded that visual estimation continues to be unreliable and inconsistent. Furthermore, visual estimation of blood loss consistently underestimates how much blood was lost following childbirth. Consequently, the seriousness of PPH may be greater than those taking care of a new mother realize. However, visual estimation is the easiest and most popular method of measuring of blood loss. In rural areas of Africa, most births take place in the home outside a hospital, so researchers came up with a way for birth attendants to easily assess blood loss.
In Eastern Africa, the traditional garment for women is the kanga, a rectangular printed cotton fabric characterized by bright colors, designs, and an outer border. These garments are so ubiquitous that they have taken on multiple functions. In addition to wearing these as skirts, dresses, aprons, and head wraps, women carry their children in kangas and use them in their homes as curtains, towels, and blankets.
Researchers at the School of Public Health, UC Berkeley identified a two-kanga threshold for blood loss after childbirth during their study to evaluate the efficacy of the uterotonic, misoprostol. Uterotonics are drugs that stimulate uterine muscle contractions. These muscular contractions, in turn, squeeze uterine blood vessels thereby decreasing postpartum blood loss. Two saturated kangas represent blood loss of around 500 mL. Once a woman loses that much blood, treatment should be administered or the mother should be transferred to a facility for further care.(1) Previously, traditional birth attendants would refer women to secondary care once four kangas were soaked–a threshold that proved too high. Although the kanga method is not a perfect measurement, it is more accurate than other clinical estimations, especially visual estimation. The ability to recognize PPH and seek treatment is the first step towards better outcomes for mothers.
The kanga saturation method provides a basis for creating simple blood collection methods applicable to women around the world, not only in places where kangas are worn. Calibrated containers, absorbent blood mats, and collecting pelvis bags are also useful for directly measuring blood loss. Because most deaths from PPH occur in low-resource settings, low-cost methods of identifying PPH provide sustainable and effective solutions for recognizing PPH before it is too late to treat.