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Assisted delivery in developing countries

NESTA-funded project (www.nesta.org)

Collaborators: Cardiff University; London School of Hygiene and Tropical Medicine; University of Birmingham; Gahini Hospital, Rwanda.

Warwick MEng students: Paul Davis and Daniel Lester


In excess of 800,000 women worldwide died during childbirth in 2005. Over 98% of those deaths occurred in developing countries. Of the 20 countries with the highest maternal mortality ratios, 19 are in sub-Saharan Africa. Maternal mortality ratios range from 1,300 per 100,000 births in African countries such as Rwanda, to 3 per 100,000 births in European countries such as Sweden. Such large differences in numbers of women dying in childbirth suggests that most of these deaths may be easily preventable.

Obstructed labour occurs when a foetal head fails to adequately progress along the birth canal during labour. Foetal and maternal compromise and death can ensue. Such complications are responsible for one fifth of maternal deaths in developing countries; accounting for up to 45% in Africa. Large epidemiological studies indicate that untreated obstructive labour has 8% mortality, 25% probability of incontinence and a 12% chance of a vaginal fistula developing; babies born in these circumstances have a tragic 12% chance of death.

The Burnell Ventouse is a product that could limit the complication rate during assisted deliveries. A ventouse is a suction cup (see image, right) which is attached to the baby's head to pull it gently into the birth canal. The Burnell ventouse is simple, cheap to produce, and has an innovative design (PCT filed). Worldwide, obstetrics experts recognise that ventouse deliveries minimise maternal and foetal trauma and death. This product could have a massive impact on the mortality and morbidity of mothers and babies worldwide. A significant contribution to the number of lives saved can be made to the World Health Organization (WHO) Millennium Development Goals (IV and V) to prevent the avoidable deaths of mothers and babies worldwide.

From our discussions, training and work with obstetricians, we are convinced any device that makes obstructed labour safer and easier to manage would have widespread uptake by doctors and midwives in the developing world. There is currently a massive shortage of trained specialist obstetricians in many of the countries where they are needed most. Our surgical device has been designed to operate in this environment, overcoming such gross deficits in the care received by labouring mothers. The Burnell Ventouse incorporates several safety features (not available in other similar devices) to enable lower-grade medical staff or healthcare professionals such as nurses to safely and quickly perform ventouse deliveries with relatively little training and experience.

Research Programme

We are currently designing and patenting the ‘Burnell Ventouse’, a reusable and portable surgical tool that can be used for the fast delivery of babies that are in foetal distress. This can be used within hospitals or in isolated rural settings. We predict our simple design will be cost accessible to all developing world hospitals and clinics. We expect this improvement in quality of care will minimise avoidable mother and baby morbidity and mortality.

The ‘Burnell Ventouse’ assists natural birth by helping to avoid emergency surgery and the complications that may ensue. Like other ventouse designs, it has advantages over all other available forms of assisted delivery, including lower foetal and maternal mortality. It can be used safely in relatively inexperienced hands – a crucial design feature within the developing world, where specialist obstetric care is at a premium.

Current funding has allowed us to build a prototype which is to be tested in the field in Rwanda. We are currently seeking ethical approval. Using the funding from NESTA, we would like to improve on the current prototype design by incorporating changes which will be identified during the initial field testing. We would then like to adapt the design to produce an improved product and co-ordinate a detailed clinical trial in the field.

 

A typical suction cap

 

A ventouse (suction cap)