Gynuity shares research and programmatic updates in maternal health

Gynuity Health Projects works with partners globally on promising interventions to improve the diagnosis and management of preeclampsia and postpartum hemorrhage (PPH). Our efforts are focused in limited-resource environments and community settings where the need for simple, cost-effective and low-tech solutions is the greatest. Three recent publications share evaluations of new approaches that can aid in prompt recognition and clinical care of women at risk of experiencing a life-threatening complication. This research was completed in Bangladesh, Egypt, Mexico, Pakistan, Senegal and Uganda. We also describe our newest endeavor to develop a simple obstetric early warning smartphone app for birth companions to assist in active postpartum monitoring of women.

Published Research

Congo Red test for identification of preeclampsia: Results of a prospective diagnostic case-control study in Bangladesh and Mexico

Preeclampsia and eclampsia are pregnancy-specific hypertensive disorders and leading causes of maternal and perinatal morbidity and mortality. Failure to diagnose these conditions and delayed administration of treatments contribute to high rates of more advanced disease. Several biomarkers have been identified as potentially useful tools for the prediction or diagnosis of preeclampsia. Laboratory-based investigations have shown that specific types of proteins associated with preeclampsia/eclampsia are excreted in the urine of women and bind to Congo Red dye (“congophilia”); this observation has led to the development of a paper-based, diagnostic tests than can be used in outpatient settings and at the bedside. Our study reports the diagnostic accuracy of a prototype point-of-care test for detection of urine congophilia in women presenting for delivery at two tertiary hospitals in Bangladesh and Mexico. Results from this prospective, case-controlled trial (n=204 preeclampsia; n=205 uncomplicated pregnancies) suggest that urine congophilia can be rapidly identified and that a point-of-care diagnostic for detection of urine congophilia has the potential to improve the triage and diagnosis of patients with preeclampsia/eclampsia. Read full article.

The safety and feasibility of a Family First Aid approach for the management of postpartum hemorrhage in home births: A pre‑post intervention study in rural Pakistan

Sublingual misoprostol 800mcg is recommended for treatment of PPH when oxytocin is not available. Increasing the availability and knowledge of misoprostol’s role as a treatment option for PPH may extend care to women who experience excessive bleeding when delivering outside of facilities. Gynuity and partners evaluated the safety and feasibility of a family first aid model of PPH detection and management in which women and their families received four 200mcg misoprostol pills in advance of delivery to use, if needed, as first aid for heavy bleeding following home births in rural Pakistan.  Over 4,000 women were enrolled in this community-based, prospective pre-post intervention study conducted in Sindh Province, Pakistan where referral is the standard of care when PPH occurs. Pregnant women were dispensed tablets and, along with their families, counseled on how to identify heavy postpartum bleeding, when and how to take the medication, and how to manage possible side effects. Results confirmed appropriate use of misoprostol in response to heavy bleeding, and satisfaction with use of the medicine was high. A self-care or Family First Aid approach may be particularly useful in contexts where there are no birth attendants other than family members. Read full article.

Postpartum infection, pain and experiences with care among women treated for postpartum hemorrhage in three African countries: A cohort study of women managed with and without condom-catheter uterine balloon tamponade

This paper presents results from a cohort study nested within a large, multisite stepped wedge cluster-randomized trial evaluating training and introduction of condom-catheter uterine balloon tamponade (UBT) for treatment of refractory PPH. Within this study, we addressed research questions around the level of postpartum pain and the risk of postpartum infection associated with use of UBT in 18 secondary level facilities in Egypt, Senegal and Uganda.   Among women diagnosed with PPH, 58 received a UBT for treatment of refractory hemorrhage, and 2,188 received interventions other than UBT. The study showed that UBT did not result in an increased risk of postpartum infection. During the immediate postpartum period, women treated with UBT reported higher levels of pain, compared to women who did not receive UBT. Most women were generally satisfied with their PPH care, though some women reported that medications and medical supplies were unavailable and they were asked by hospital staff to purchase the needed supplies. These finding help us to understand women’s experiences of care and identify areas for quality improvement that could go hand-in-hand with introducing interventions like UBT. Read full article.

New Research

Developing a simple obstetric early warning smartphone app for birth companions to assist in active postpartum monitoring of women

The effectiveness of many interventions can depend on good routine monitoring in the immediate postpartum period so that complications are promptly identified and treated. Too often, resource-constrained settings do not have adequate staff to provide adequate monitoring. When complications occur, delays in diagnosis can result in the need for more invasive treatments to save women’s lives or, in the worst case, maternal death. In the UBT study (described above), it was found that 20% of women who delivered at secondary facilities in Uganda and who eventually received treatment for PPH had initially identified the heavy bleeding on their own or with support from their birth companions. In response to the need for improved monitoring, a new research project is planned to develop a simple obstetric early warning smartphone app for birth companions to assist in active postpartum monitoring of women. This app will be developed and tested in Uganda and could fill a gap in care that arises from the frequently poor quality of postpartum monitoring in low- and middle-income countries.    We thank our donors who have generously supported this pilot research. We are actively seeking additional support to explore the utility of a monitoring app in other settings.

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