How Epsom salt can save the lives of women with preeclampsia

May 21, 2019 by Dr. Patricia Coffey

Advancing an innovative intervention to prevent and treat one of the leading causes of maternal mortality.

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Photo: PATH. Pregnant women at a primary health care center in Nigeria.

May 22 is World Preeclampsia Day

When you think about lifesaving drugs, you may not think immediately about Epsom salt. But for 10 million women who develop the pregnancy complication of dangerously high blood pressure or preeclampsia and eclampsia (PE/E) during pregnancy each year, Epsom salt is the recommended first-line treatment. Epsom salt, also known as magnesium sulfate, is used both as a prophylactic to prevent the onset of eclampsia and as an anticonvulsant to treat eclamptic seizures.

The magnesium sulfate is administered as a liquid solution via an intravenous infusion or, in low-resource settings without infusion pumps, via intramuscular injection. While these intramuscular injections can save the life of a woman with PE/E, this method of delivery of magnesium sulfate can be painful for the patient and challenging for providers. Health providers know that standard guidelines for the preparation and provision of magnesium sulfate for PE/E exist, yet they do not always remember them because PE/E may not happen often in smaller facilities. Also, providers may not always feel confident about administering magnesium sulfate, because an overdose of magnesium sulfate can be toxic.

Infusion pumps, like those used in high-resource settings, could provide an easy, safe, and reliable way to administer lifesaving magnesium sulfate. However, for facilities with limited resources, there are many barriers to access, including the high cost of purchase, repair, parts, and training, as well as a lack of reliable electricity to run the equipment.

A 2018 publication estimated 59 percent of health care facilities in low- and middle-income countries lack access to reliable electricity. Available nonelectric options for controlled fluid delivery require expensive, proprietary disposable tubing that prevents easy medication adjustment and introduces cost and supply chain challenges.

Recognizing this challenge, PATH—in partnership with Dr. Anthony Roche of the University of Washington’s Department of Anesthesiology and Pain Medicine at the School of Medicine and Department of Global Health, and Dr. Karl Weyrauch of the Pygmy Survival Alliance—designed the RELI Delivery System to be appropriate for treating pediatric and obstetric emergencies in low- and middle-income countries.

A prototype of the RELI Delivery System

Photo: PATH/Patrick McKern.

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PATH’s RELI Delivery System is a reusable, electricity-free, low-cost infusion pump that can be used to treat obstetric emergencies like PE/E in settings with unreliable power. It has a simple user interface that is easy to learn, use, and understand, and it requires no electricity or batteries to operate. The robust design is also inexpensive to maintain and does not require expensive or proprietary consumables to function. To operate the device, the user pumps up the air tank, selects the flow rate, and begins the infusion.

Photo: PATH. Nurses at Naguru Hospital review the RELI prototype in Kampala, Uganda as part of PATH’s user centered design activities.

Photo: PATH. Nurses at Naguru Hospital review the RELI prototype in Kampala, Uganda, as part of PATH’s user-centered design activities.

Our team at PATH is refining the functionality and user interface of the RELI Delivery System prototype. We are currently seeking manufacturing and commercialization partners who are based in target markets for future market entry.

Photo: PATH.

PATH Product Development Engineer Geneva Goldwood discussing the RELI Delivery System prototype with Dr. Anthony Roche, University of Washington School of Medicine and Department of Global Health.

The RELI Delivery System is one of the many devices, diagnostics, and drugs that PATH is identifying and developing in partnership with research institutions, manufacturers, and companies in Africa to introduce into key African markets to combat maternal mortality.

Today, on World Preeclampsia Day, we are thrilled to acknowledge all of the innovators, researchers, and health providers who are working hard to find new ways to address the age-old issue of preeclampsia. Together, we will make strides to ensure the survival of pregnant and birthing women.