Birthing a Babe in the Wild
Far away from hospitals and emergency care, what can we do?
Sub-Saharan Africa and Southern Asia accounted for nearly 90% of the estimated global maternal deaths in 2017. Africa alone accounted for two-thirds (200,000) of maternal deaths, while Southern Asia accounted for one-fifth (60,000). The risk of maternal mortality is highest for girls under 15 years old and complications in pregnancy and childbirth are higher among girls age 10-19. Severe bleeding after birth can kill within just a few hours.
What can be brought out into the field to address this grave need?
Post Partum Hemorrhage Interventions
In standard hospital practice doctors give women the hormone oxytocin, via IV or IM, to stimulate the uterine muscle to squeeze and stop the bleeding by physically closing open vessls. However it is not an option in many places due to its instability in heat and humidity. It degrades when stored above 86 degrees Fahrenheit.
So Ferring Pharmaceuticals developed a heat-stable version of an oxytocin-like molecule - Carbetocin- with potency/stability at 86 degrees F for 3 years and at 104 F for 6 months. It was tested head to head in a noninferiority comparison trial with standard oxytocin in a large 30,000 patient trial in 10 countries.
Blood loss was similar in both groups, demonstrating noninferiority of Carbetocin to oxytocin. About 14.5% of women in both groups lost at least a half liter of blood after delivery. The number of women losing more than a liter of blood wasn't statistically different for the two groups: 1.45% for women who received oxytocin and 1.51% for the carbetocin group.
This represents real life betterment of the lives of the world’s women.
Neonatal Jaundice
Now, what about the babes? Hemolysis of their blood is common, often due to ABO blood type incompatibility but also malaria infections. It leads to increased bilirubin levels which can lead to brain damage in the neonate. Here is an encouraging advance in Point of Care diagnostics in the field:
More than 60% newborns experience hyperbilirubinemia and jaundice within the initial week after birth due to the accumulation of total bilirubin in blood. Left untreated high levels of bilirubin may result in brain impairment. Simple, fast, accurate, low-cost and timely point-of-care (POC) analysis of total bilirubin is an unmet need especially in resource-limited areas.
This work introduces a novel sensing device, named a “tape-paper sensor”, capable of separating plasma from whole blood and measuring total bilirubin by a colorimetric diazotization method. The tape-paper sensing method overcomes non-homogeneous color distribution caused by the “coffee stain” effect, which improves the accuracy of colorimetric evaluation on paper-based analytical devices. The level of hemolysis in the plasma extracted by the device is evaluated, confirming no interference in the detection of total bilirubin. The accuracy of the tape-paper sensing approach for neonatal blood sample measurement is verified by comparison with the hospital pathology laboratory method.
The small volume of samples and reagents, minimal equipment (an office scanner), fast detection (<10 min) and low fabrication cost (∼A$ 0.6) reveal the suitability of the device for POC use and in resource-limited settings. The tape-paper sensor is a low-cost, fast, and user-friendly device for measurement of blood total bilirubin levels in neonatal jaundice diagnostics. - W Tan et al.
Malaria diagnostics
Both babies and moms are often anemic and weakened by chronic bouts with malaria, putting them at further risk of death. A very clever inventor - Manu Prakash - created low cost paper product based centrifuges and microscopes to address the problem of diagnosing the infection in areas without power and machines.
He used origami folding to make a completely functional microscope out of paper - ”Foldascope” - that can identify the parasites in blood samples.
But how can they prepare the blood for viewing under that Foldascope? Well, he went on to create a simple paper and string based centrifuge -”Paperfuge”.
"We were out in a primary health center talking to health care workers and we found a centrifuge used as a doorstop because there's no electricity." The workers said that they really needed a powerful centrifuge that they could use anywhere. And it needed to be cheap. -Manu Prakash
This time he turned to the children's toy known as the whirligig, or buzzer.
The toy is made of a disc that spins when a person pulls on strings that pass through the center. The invention derived from it, is made out of a strong paper coated in a polymer film, string and PVC pipe or wood. Blood samples go in the center of the disc and then pulling on the strings causes the cells to separate. The paperfuge achieves speeds of 125,000 rpm (and equivalent centrifugal forces of 30,000 g), with theoretical limits predicting 1,000,000 rpm. It can separate pure plasma from whole blood in less than 1.5 min, and isolate malaria in 15 min. The samples can then be processed and tested for parasites, using the previously described Foldascope.
Wow. So clever! And what a huge impact he makes.
He inspires us all.
REFERENCES
https://www.who.int/en/news-room/fact-sheets/detail/maternal-mortality
Heat-Stable Carbetocin versus Oxytocin to Prevent Hemorrhage after Vaginal Birth https://www.nejm.org/doi/full/10.1056/NEJMoa1805489?query=featured_home
W Tan et al. Three-dimensional microfluidic tape-paper-based sensing device for blood total bilirubin measurement in jaundiced neonates https://pubs.rsc.org/en/content/articlelanding/2020/LC/C9LC00939F
https://www.rsc.org/suppdata/c9/lc/c9lc00939f/c9lc00939f1.pdf
Kid's Toy Inspires Low-Cost Lab Test for Diagnosing Malaria https://www.kqed.org/futureofyou/318708/kids-toy-inspires-low-cost-lab-test-for-diagnosing-malaria
M Saad Bhamla et al. Hand-powered ultralow-cost paper centrifuge https://www.nature.com/articles/s41551-016-0009
A $1 Microscope Folds From Paper With A Drop Of Glue https://www.npr.org/sections/goatsandsoda/2014/09/03/345521442/a-1-microscope-folds-up-from-paper-and-a-lens-of-glue
Please subscribe to my free newsletter by clicking the button. Many future stories will be exclusive to only paid subscribers to BioMedWorks Newsletter: the PREMIUM CONTENT. I would be grateful if you do go on to upgrade to the paid subscription for just $5 a month or $50 a year.
