‘Harvard’ helps State’s 11 medical colleges to reduce maternal deaths due to PPH
| Date :03-Mar-2020 |
By Vikas Vaidya :
Vidarbha’s NKPSIMS, Nagpur; GMCH, Nagpur; Akola, Yavatmal; JNMC, Wardha; MGIMS, Sewagram, Wardha come out with fantastic result of 60% reduction n Every second matters while saving mothers life due to PPH
It was in 2017, when a woman at Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sewagram, Wardha immediately after delivery was bleeding. It was a case of Post Partum Haemorrhage (PPH). Dr Poonam Verma Shivkumar, the lead gynaecologist used Uterine Balloon Tamponade (UBT) and miracle did take place. The bleeding was stopped. Since then MGIMS did not register a single maternal death. What is Uterine Balloon Tamponade and who discovered it? Post Part Haemorrhage (PPH) is one of the major causes of maternal deaths. It is unpredictable, though there are risk factors as anaemia, high blood pressure, multiple pregnancy.
Post Partum Haemorrhage is bleeding more than 500 ml after vaginal delivery or 1,000 ml after LSCS or any amount which alters pulse and blood pressure of the delivered mother. (A lower (uterine) segment Caesarean section (LSCS) is the most commonly used type of Caesarean section. It includes a transverse cut 1-2 centimetres above the attachment of the urinary bladder to the uterus, called the Pfannenstiel incision in the lower segment. LSCS is done on the women in case of multiple pregnancy, severe hypertensive disease in pregnancy, fetal conditions: distress, iso-immunisation, very low birth weight, failed induction of labour). In management of atonic PPH Every Second Matters (ESM) plays an important part. There are various modalities of treatment, medical and surgical.
Medical management is first line of treatment and when patient does not respond to the use of Uterine Ballon Tamponade and non pneumatic anti shock garment is used. MGIMS first approached Dr Thomas Burke from Massachusetts General Hospital, Harvard University, USA who along with his team working on a WHO project - Use of condom uterine balloon for atonic PPH where a condom filled with fluid is inserted in the uterine cavity to stop bleeding. He discovered a UBT and patented it.
It has proved a boon to the mothers. Dr Poonam Verma Shivkumar from MGIMS became team leader along with ten more medical colleges from India comprising Dr Anuja Bhalerao from NKPSIMS Nagpur, Dr Fidvi, Dr Ashish Zararia from GMCH Nagpur, Dr Deepti Shrivastava from Jawaharlal Nehru Medical College, Wardha; Dr S Gaddapa, Dr Rupali from GMC, Aurangabad; Dr Shabana, Dr Aruna Kumar from Bhopal, Dr Bangal from Loni, Dr Pushpa Junghare, Dr Sayali from Dr Punjbarao Deshmukh Medical College, Amravati; Dr Chavhan from GMC, Yevatmal; Dr Kshama Kedar from NARCHI, Nagpur; Dr Wahane from Akola are working since last 2 years as advocates of maternal health pursuit of a change. The project aimed at preventing PPH, Treating PPH and saving mothers. Dr Poonam Verma Shivkumar explained, “Preparing to tackle PPH is the key, be it in a private hospital, Government hospitals.
Training and imparting knowledge not only of UBT or NASG but also team work and communication, facility readiness, postpartum monitoring is being done for all the doctors, ANM's, ASHA workers throughout districts, to improve lives of so many women. Certain problems as non-availability of drugs, blood products, transfer facility were detected and with timely communication and perseverance of the team leaders, the problems were resolved.” (NASG means non-pneumatic anti-shock garment is a low-technology first-aid device used to treat hypovolemic shock. Its efficacy for reducing maternal deaths due to obstetrical hemorrhage is being researched. Obstetrical hemorrhage is heavy bleeding of a woman during or shortly after a pregnancy).
It is worth mentioning, over a period of two years, the maternal mortality is almost zero and operative interventions, obstetric hysterectomies for atonic PPH have reduced significantly with timely use of uterine balloon tamponade and NASG, Simulations, debriefing, PPH bundle approach, respectful maternity care, help lines, communication, informed Dr Poonam Verma Shivkumar. Complex Preposition of PPH management is aptly integrated for its easy implementation in preventing untimely maternal deaths, pointed out Dr Anuja Bhalerao, a well-known gynaecologist of NKPSIMS, is a part of the project. Dr Thomas Burke has given his patent to Hindustan Latex Limited (HLL) and Government of India is looking into this for supply of condom uterine balloon kits all over India. This team of doctors is now going to implement this approach in Uttar Pradesh and Bangladesh under the aegis's of Government of India .