MacArthur commits $11 million to further UCSF work in maternal safety

Suellen Miller, CNM, PhD

The John D. and Catherine T. MacArthur Foundation has promised $10.75 million to extend a ground-breaking UCSF project to help combat maternal mortality in Nigeria and India - two countries that comprise one-third of all maternal deaths worldwide.

MacArthur Foundation President Jonathan Fanton announced the grant today in London at the Women Deliver conference.

The funding will go to the nongovernmental organization Pathfinder International, which will use the grant to implement a spectrum of interventions developed and tested by UCSF researchers to treat women suffering from post-partum hemorrhaging. UCSF will continue to advise the group on the roll-out, including development of a plan for monitoring and evaluating the project’s outcomes.

The centerpiece of the program is the non-pneumatic anti-shock garment, or NASG, a low-cost and reusable body suit made of lightweight neoprene that was originally designed for battlefield use. When the suit’s five Velcro closures are tightened around the patient’s body, the compression stops blood from flowing to the lower extremities and forces it back to the heart, lungs, and brain to counteract shock.

The suit has now been shown to effectively stem hemorrhaging after childbirth, according to Suellen Miller, CNM, PhD, who proposed the garment’s use as a maternal life-saver and pilot-tested the project in Egypt over the past four years with Egyptian colleagues Mohammed Mourad Yousiff, MD, from El Galaa Maternity Hospital, in Cairo; and Mohamed Fathalla, MD, from the Assiut Teaching Hospital, in Assiut.

“It is tremendously gratifying to see this work being expanded by Pathfinder,” said Miller, an associate professor in the UCSF Department of Obstetrics, Gynecology and Reproductive Services and director of the Safe Motherhood Programs of the UCSF Women’s Global Health Imperative.

“Hundreds of thousands of new mothers die needlessly every year due to hemorrhaging, simply because they don’t have access to a hospital,” she said. “This simple garment appears extremely promising in pilot studies and could potentially have a huge impact on the lives of both the women and their families.”

In the pilot study, 158 obstetrical hemorrhage patients underwent standard hemorrhage treatment and 206 patients with obstetrical hemorrhaging underwent standard treatment plus the anti-shock garment.

Study results showed a 50 percent decrease in blood loss among women treated with the garment, which is statistically significant, Miller said. Pilot results, which were published in the April 2006 issue of the “British Journal of Obstetrics and Gynecology,” showed a 69 percent decrease in death and severe illness.

“In our research, women who appeared clinically dead, with no blood pressure and no palpable pulse, were resuscitated and kept alive for up to two days until they could be transported to a hospital,” said Miller.

The World Health Organization estimates that 529,000 women died in pregnancy or childbirth in the year 2000. More than 99 percent of these deaths occurred in developing countries, where Miller said the majority of women give birth at home, with poorly trained or untrained attendants. Of the risks, postpartum hemorrhage is the most common cause of maternal mortality, accounting for approximately 25-30 percent of all maternal deaths.

Pathfinder will use the MacArthur grant to introduce a package of low-tech interventions at several hundred health facilities in seven Indian states and eight states in Nigeria. Those interventions, called the Continuum of Care for PPH (post partum hemorrhage), were developed by Miller and Stacie Geller, PhD, an associate professor at the University of Illinois College of Medicine.

The package of interventions includes the anti-shock garment, a uterus-contracting drug to prevent bleeding, a calibrated blood collection drape to diagnose postpartum hemorrhage, and a community-developed communication and transportation plan to get patients to a health facility for assessment and emergency obstetrical treatment.

“It is important to address postpartum hemorrhage wherever there is the potential for it to occur, from the community up through the health system,” said Dan Pellegrom, president of Pathfinder International. “Prevention and management starts in homes and communities, so it is important to cultivate informed and engaged communities that are aware of the danger signs of hemorrhaging and can transport women to skilled service providers.”

The current funding builds upon nearly $2 million in previous MacArthur grants to UCSF for preliminary pilot studies of the anti-shock garment in Egypt, Mexico and Nigeria. Fanton, from MacArthur, said the introduction of the garment on a large-scale could help save hundreds of thousands of lives and help strengthen national health care systems.

“No other major cause of maternal death can be prevented as easily as postpartum hemorrhage,” Fanton said. “Our hope is that the anti-shock garment will eventually become part of a standard package of care for postpartum hemorrhage in developing countries.”

Miller and her team will continue a rigorous NIH funded randomized cluster trial of the garment in Zambia and Zimbabwe.

The John D. and Catherine T. MacArthur Foundation is a private, independent grant making institution dedicated to building a more just and sustainable world. Through the support it provides, the Foundation fosters the development of knowledge, nurtures individual creativity, strengthens institutions, improves public policy, and provides information to the public, primarily through support for public interest media. With an endowment over $6.4 billion, the Foundation makes grants totaling approximately $225 million each year. More information is available at www.macfound.org.

Pathfinder International provides women, men, and adolescents throughout the developing world with access to quality family planning and reproductive information and services. Pathfinder works to halt the spread of HIV/AIDS, to provide care to women suffering from the complications of unsafe abortion, and to advocate for sound reproductive health policies in the US and abroad. More information is available at www.pathfind.org.

UCSF is a leading university dedicated to defining health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. For more information, please visit
www.ucsf.edu.

## Further Contacts:

Jen Humke, MacArthur Foundation, 312-726-8000, [email protected]
Cara Hesse, Pathfinder International, 617-924-7200 x 216, [email protected]