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Simple diagnostic saves lives

Professor of Obstetrics Andrew Shennan at King’s College London has developed a simple diagnostic device to measure blood pressure, pulse and detect shock in pregnant women. He’s now putting it to the test in a large trial across 10 centres in eight countries funded through the Joint Global Research Programme for Women’s and Children’s Health in collaboration with India’s Department of Biotechnology.

Pregnant woman stands in an alleyway with a bike

Photo credit: Meena Kadri under CC BY 2.0

It’s taken 10 years but we finally have it. It’s cheap, it’s easy to use and it could save the lives of thousands of women every year.

Every day, approximately 800 women die during pregnancy or childbirth. 99 per cent of all of these deaths happen in low income settings. Women who live in rural communities, with limited access to healthcare, are at the greatest risk. Usually, these women die from severe bleeding, infections or blood pressure problems and often, they die because the problem is recognised too late.

Physical changes during pregnancy demand different diagnostics

Monitoring a woman’s blood pressure and pulse could save her life in all of these situations. Of course there are devices out there that measure these things, but normal devices can’t give an accurate reading because your blood flow changes during pregnancy. You have a bigger volume of blood when you’re pregnant and it flows around your arms and legs with less resistance. More importantly, if you get ill, the type of high blood pressure you get is different than in, for example, older men. Normal devices could give readings that are way out, missing the vital opportunity to diagnose a problem and save a life.

Photo: healthcare worker in a hospital setting using the device with a pregnant patient.

The shock measuring-device in action. Image credit: King’s College London

Shock traffic light triaging

So we have developed a simple, accurate, handheld device to measure blood pressure and pulse. Importantly and uniquely, it detects developing shock using these measurements, long before carers might realise. It combines increasing pulse with falling blood pressure and triggers a traffic light indicator when this is serious.

To get this right was a simple yet laborious task. We took readings in women, we looked at the signal, and we changed the algorithm a little bit at a time. Tweak, tweak, tweak. Over many, many years we eventually got it right.

Photo: healthcare worker using the device with a pregnant woman in her home.

Small and compact, robust and cheap, the device has low power requirements making it suitable for low-income settings. Image credit: Kings College London

Part of the device’s success is thanks to its traffic light system. It tells the user if the blood pressure and pulse measurements are normal (green), worrying (amber) or severely abnormal (red). It also tells you when the triggers are due to shock or high blood pressure. That lets untrained observers know sooner when a woman needs to be referred to higher-level care.

The right tool for the job

Small and compact, robust and cheap, the device has low power requirements making it suitable for low-income settings. And you can use it even if you aren’t medically trained.

Scaling up

Our previous trials have shown that it works and that people are happy using it. Now our Newton-funded project is testing its efficacy on a much larger scale. The trial is based in 10 centres: two in Zambia, two in Uganda, and one each in Sierra Leone, Ethiopia, Malawi, Zimbabwe, Haiti and in India.

We want to test the impact it has in large communities where there are a lot of serious problems in pregnancy. That way we can work out whether it’s really worth backing with more funding in the future. We’ve gone to so many different centres across the world because we think there will be different implications for different communities. Funding from the Department of Biotechnology in India helped to give us new insights into delivering research in a different setting. Combining all our efforts has resulted in a better project than any of us could have done alone.

To manage the trial in each centre we’ve approached a number of different investigators, usually obstetricians who also have an interest in research. We’ve worked closely with them to ensure everyone gets the training they need to use the device and collect reliable data.

I have long believed that you save most lives not with sophisticated treatments in hospital, but by recognising problems quickly. And that is what this device can do.

Photo: Andrew pictured with six team members in a hospital setting.

Andrew with members of his team at a meeting in Capetown, South Africa. Image credit: Andrew Shennan.

This funding, awarded through the Joint Global Research Programme for Women’s and Children’s Health in collaboration with the Department of Biotechnology in India as part of the MRC-Newton Fund partnership with India, has allowed Andrew to set up a clinical trial, CRADLE 3.

Hear more about Andrew’s project in our MRC talks podcast

Read about more Newton Fund projects.

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