Postpartum hemorrhage management a critical step for maternal health in Malaysia

Postpartum hemorrhage (PPH), which occurs when a woman experiences excessive bleeding after childbirth, remains one of the leading causes of maternal mortality worldwide.

According to the World Health Organization (WHO), approximately 14 million women globally suffer from PPH each year, and one woman dies from this condition every 6 minutes. In Malaysia, PPH is one of the top causes of maternal mortality and accounted for 17.5 percent of maternal deaths in 2019. The Department of Statistics Malaysia (DOSM) reported a maternal mortality ratio (MMR) of 26 per 100,000 live births in 2022, an improvement from 44 per 100,000 in 1991. [Available at https://www.dosm.gov.my/portal-main/release-content/statistics-on-causes-of-death-malaysia-2020 Accessed on 25 June 2024]

Currently, PPH management protocol predominantly involves the use of uterotonics such as oxytocin, methylergonovine, carboprost, or misoprostol; non-surgical methods like balloon tamponade; surgical techniques including compression sutures, internal iliac artery, ovarian artery, and uterine artery ligations, and peripartum hysterectomy; endovascular interventions such as uterine artery embolization; as well as the administration of antifibrinolytics (tranexamic acid and procoagulants). [Turk J Anaesthesiol Reanim 2022;50(6):396–402]

The high incidence of PPH in Malaysia necessitates the need for innovative and effective management strategies. Thus, the introduction of the new Jada® System, which offers a rapid and reliable solution to PPH, could potentially reduce maternal mortality rates. The Jada System is a device that utilizes low-level vacuum technology to quickly induce uterine contraction resulting in a median quantitative blood loss of 110 mL during treatment. The rapid action of this device is helpful in managing PPH, where time is a crucial element in determining the survival of mothers. Providing the evidence for Jada System’s efficacy and safety was the PEARLE* study where the device was shown to resolve bleeding in a median of 3 minutes, with 94 percent of patients experiencing successful bleeding control without the need for further treatment. Additionally, the device has been rated as easy to use by 98 percent of investigators. [Obstet Gynecol 2020;136(5):882–891]

Additionally, the RUBY** study, a real-world data from a multicenter, observational, post-market registry study designed to collect observational data on patients treated with the Jada System echoed the same findings as the PEARLE study. Additionally, the RUBY study revealed that the Jada System worked best when bleeding was <3000 mL, hence the call for earlier intervention.

Speaking at the launch of the Jada System, Professor Dr Jamiyah Hassan, Senior Obstetrics and Gynecology and Fetal Medicine Consultant at Hospital Al-Sultan Abdullah, said continued focus on innovative approaches and technologies is vital in ensuring every woman can access the best possible maternal care, ultimately saving lives and enhancing the well-being of families and communities. Also present at the event were Professor Datuk Dr Harlina Halizah Hj Siraj, Professor of Obstetrics and Gynecology and Clinical Education at the Faculty of Medicine, Universiti Kebangsaan Malaysia, and Bilal Somra, Executive Director and Country Lead of Organon Malaysia.

Note: PPH occurs when there is an excess blood loss of >500 mL post vaginal birth or >1000 mL after Caesarean section. When bleeding occurs within the first 24 hours after delivery, it is considered primary PPH. Secondary PPH is defined as bleeding that occurs 24 hours to 12 weeks postpartum.

*PEARLE: Prospective, Single Arm Pivotal Clinical Trial Designed to Assess the Safety and Effectiveness of the Jada System in Treating Primary Postpartum Hemorrhage

**RUBY: Treating Abnormal Postpartum Uterine Bleeding or Postpartum Hemorrhage with the Jada System