STITCH

The leading cause of maternal deaths worldwide is postpartum hemorrhage (PPH). According to the World Health Organization, 14 million women experience PPH each year, resulting in 70,000 maternal deaths around the world annually [1]. These maternal deaths are inequitably distributed globally, and the burden is largely borne by those who live in low- and middle-income countries (LMICs) where maternal mortality ratios are 65 times higher than in Canada and may be up to 147 times higher [2]. Despite these staggering numbers, with adequate and timely interventions – including advanced surgical techniques – the majority of these devastating deaths are preventable, and progress may be made towards achieving Sustainable Development Goal 3’s (SDG3) Target 3.1 “decrease the global maternal mortality ratio to less than 70” [3].

The most common cause of PPH is uterine atony, defined as a lack of adequate tone and contraction in the postpartum uterus [4-6]. Currently, uterotonics (drugs which induce uterine contraction) are the gold standard for the prevention and treatment of PPH [7]. However, these drugs may not be accessible in many LMICs due to a combination of cost, supply chain challenges, and systemic barriers [8]. In their absence, timely surgery consisting of a trio of surgical procedures is necessary to stop the bleeding and save the patient. STITCH, a PPH surgical simulator, provides the opportunity for healthcare providers to teach, learn, and practice these critical procedures in a controlled and low-stakes environment before a patient is on the operating room table. End-users include not only providers in LMICs but also those in high-income countries like Canada in both urban and rural settings.

Sources:
[1] World Health Organization. Postpartum Haemorrhage. [WHO website]. 2024.

[2] World Health Organization. Trends in maternal mortality 2000 to 2020. [WHO website]. 2023.

[3] United Nations. The 17 Goals. [UN website]. 2023.

‌[4] S. Ngwenya, “Postpartum hemorrhage: incidence, risk factors, and outcomes in a low-resource setting,” International Journal of Women’s Health, Nov. 02, 2016. (accessed May 1, 2024)

[5] J. BAI, Q. SUN, and H. ZHAI, “A comparison of oxytocin and carboprost tromethamine in the prevention of postpartum hemorrhage in high-risk patients undergoing cesarean delivery,” Experimental and Therapeutic Medicine, vol. 7, no. 1, pp. 46–50, Nov. 2013, doi: https://doi.org/10.3892/etm.2013.1379.

[6] T. Amanuel, A. Dache, and A. Dona, “Postpartum Hemorrhage and its Associated Factors Among Women who Gave Birth at Yirgalem General Hospital, Sidama Regional State, Ethiopia,” Health Services Research and Managerial Epidemiology, vol. 8, p. 233339282110627, Jan. 2021, doi: https://doi.org/10.1177/23333928211062777.

[7] I. Gallos et al., “Uterotonic drugs to prevent postpartum haemorrhage: a network meta-analysis.”. NIHR Journals Library, 2019.

[8] Sheldon WR, Blum J, Vogel JP, Souza JP, Gülmezoglu AM, Winikoff B; WHO Multicountry Survey on Maternal and Newborn Health Research Network. Postpartum haemorrhage management, risks, and maternal outcomes: findings from the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG. 2014 Mar;121 Suppl 1:5-13. doi: 10.1111/1471-0528.12636. PMID: 24641530.

• Yiting Wu (She/Her) MASc at SBME

• Tara Kemper (She/Her) MASc at SBME

• Noah Stewart (he/Him) MASc at SBME

• Vincent Levandier (He/Him) MEng at SBME

• Yonghui Chan (She/Her) MEng at SBME

Partner:

• Esther Chin (She/Her), MD, MGSC, FRCSC, Obstetrician/Gynecologist, Adjunct Professor (Branch for Global Surgical Care, Faculty of Medicine, UBC)