Arri Coomarasamy of Birmingham University, UK / Birmingham University Old Joe alumni magazine.

Dr. Arri Coomarasamy, a consultant gynecologist at the Birmingham Women's Hospital in the United Kingdom and a professor of gynecology and reproductive medicine at the University of Birmingham, has devised a method that, following pioneering trials in several nations, has significantly decreased the mortality rate among women experiencing excessive bleeding during childbirth.

According to statistics, every two minutes, a mother and 17 babies die, due  to complications during pregnancy or the act of giving birth.

Born in Jaffna, Sri Lanka, of Indian descent, Coomarasamy received his undergraduate medical education from the University of Birmingham, and completed his subspecialist training in reproductive medicine and surgery at Guy’s Hospital, London.  He leads two research teams at Birmingham, one focusing on treatments to prevent miscarriages and the other targeting on ways to stop mothers dying during childbirth.

Three challenges

Prof Coomarasamy and his team identified three key challenges in responding to postpartum haemorrhage (PPH):

PPH is often detected too late to be treated effectively. Secondly, even after  the problem was picked up the treatment wasn't happening quickly enough. Time is the biggest killer in a condition that involves bleeding. Finally, Treatments were being provided one by one with gaps in between, costing valuable time if the first options were not effective. 

Low-cost solution

The trials found drastic improvements in outcomes by combining accurate measurement of blood loss with a bundle of PPH treatments. This includes a simple low cost plastic 'drape' developed to measure blood loss more effectively; placed under the mother during birth, it collects all the blood to instantly show when bleeding becomes more serious. Treatments including uterine massage, medicines to contract the womb to stop the bleeding and intravenous fluid administration delivered all at once, instead of being offered sequentially.

This resulted in the birth of E-MOTIVE - 'E' is early detection using the drape measuring method and 'MOTIVE' is the bundle of treatment. It was successful in reducing treatment delays for women who lost one litre of blood or more by 60 percent. It worked in every participating country, and throughout the trial participating hospitals continually improved their treatment and outcomes.

Explaining the development, Coomarasamy said, 'Our new approach to treating postpartum haemorrhage could radically improve women's chances of surviving childbirth globally, helping them get the treatment they need, when they need it. Time is of the essence when responding to postpartum bleeding, so eliminating delays in diagnosis or treatment should make a huge difference and our clinical trial has shown that it does.'

The results of the trials  over a period of  two years in four low and middle income countries, including Kenya, Nigeria, South Africa and Tanzania, involving over 200,000 women across 80 secondary level health facilities,  have been published in in The New England Journal of Medicine  (Randomized Trial of Early Detection and Treatment of Postpartum Hemorrhage).

While alumni support was crucial in enabling the preliminary research, the E-MOTIVE trial itself was generously funded by the Bill & Melinda Gates Foundation.

 

E-Motive in action in a Tanzanian hospital / Birmingham University Old Joe alumni magazine

 Recognized in King’s Birthday Honours

In recognition of this life-saving research and his role as the founding director of the WHO Collaborating Centre for Global Women's Health,  Coomarasamy was  awarded an OBE in the King’s Birthday Honours last summer.

Dr Fiona Reynolds, chief medical officer at Birmingham Women’s and Children’s Hospital said, “We’re incredibly proud of Arri for the positive impact he has had, on the lives of women and families across the globe in dire need of support. Not only has he had a positive impact upon his patients globally; he continues to inspire us all at BWC. Thank you, for your ambition, bravery and compassion.”

In light of these encouraging results, the World Health Organisation (WHO) is now revising its  recommendations for  clinical interventions in childbirth. And if the procedure developed by Coomarasamy and his team –E-MOTIVE --  is scaled up,  a mother’s life could be saved every 24 minutes, suggests a cover story in the latest issue of  Birmingham University’s alumni magazine  “Old Joe”.