A never-before-seen childbirth technique could help a woman’s body heal itself through temperature changes, according to a pilot study from Baylor Research Institute. In a finding that could someday decrease global maternal mortality, Baylor’s team found that cooling a woman’s uterus after a C-section can dramatically reduce postpartum blood loss.
Led by a team of physicians and nurses in labor/delivery from Baylor University Medical Center at Dallas, the study explores “uterine cooling,” an experimental method that showed significant results in early testing. The theory is based on biological fact: cold temperatures make some smooth muscles contract. The research suggests that the uterus is among that group.
“Historically, if you look at battles and warfare, it’s been known that people bleed less in areas with cold terrain or snow,” said Jack Stecher, MD, an anesthesiologist on the medical staff at Baylor University Medical Center, who helped organize the study to test that hypothesis. “So we’ve known that applying cold will help stop bleeding because blood vessels can contract.”
Testing The Theory
The study, co-created by Dr. Stecher and Jamie Crowson, CRNA, investigated the use of cold temperatures to fight uterine atony, a condition that prevents the uterus from self-contracting. It can often lead to postpartum hemorrhage, which is the leading cause of maternal death in the world, accounting for 38 instances every 100,000 births.
“It’s unique because it’s a non-threatening, non-pharmaceutical method that’s simple and that people can conceptualize…We hope to apply it on a much larger scale to see whether it decreases the need for emergency hysterectomies, blood transfusions and even more”– Dr. Janice Mitchell of Baylor University Medical Center
The two researchers engaged Janice Mitchell, MD, a physician on the medical staff at Baylor University Medical Center, who completes her medical residency this year, to serve as the study’s principal investigator. In a manuscript submitted to the American Congress of Obstetricians and Gynecologists (ACOG) annual meeting, Dr. Mitchell noted that muscular cooling has been used in other settings, including the gastrointestinal tract, bladder and respiratory tract. However, it’s never been applied to the OB world, until now.
“There was no way for us to know whether this method would work in this instance because there is no literature for using this technique in obstetrics,” Dr. Mitchell said. “But the implications are huge in that it could become a new method used more universally, especially as a first line of defense against postpartum hemorrhage.” Organizers divided the study’s participants into two groups of 100 women, all of them receiving C-sections. While uterine hemorrhage is common in both natural and surgical childbirth, the researchers studied C-section patients because the uterus is exposed during the procedure, which allowed the team to test its cooling method more easily.
Women in the control group had standard surgeries, which protect the exposed uterus with sponges soaked in a saline solution — called the Ecolab® ORS™ Hush Slush® System — at 99 degrees Fahrenheit. Women in the test group had their uteruses covered with sponges soaked in the same solution, but they were cooled to 30 degrees Fahrenheit. The women who underwent the cooling technique bled an average of 32 percent less than women in the control group. Given those dramatic differences, the results could imply big changes in obstetric practice.
“It’s unique because it’s a non-threatening, non-pharmaceutical method that’s simple and that people can conceptualize,” Dr. Mitchell said. “We hope to apply it on a much larger scale to see whether it decreases the need for emergency hysterectomies, blood transfusions and even more.”
“It is my hope to defeat uterine atony before I retire…sometime in the distant future”– Dr. Jack Stecher of Baylor University Medical Center
Benefits Beyond C-Sections
While this study was isolated to C-section patients, the findings suggest uses for uterine cooling beyond surgery, including during intrauterine balloon procedures after vaginal delivery.
“Vaginal births comprise nearly two-thirds of all deliveries, and those patients are still at risk for uterine atony and bleeding,” said Crowson, a nurse anesthetist on the allied health professional staff at Baylor University Medical Center. “In these cases, intrauterine balloon devices inflated with saline are sometimes placed to slow and stop bleeding.” Chilling those balloons could represent an opportunity to apply these findings to vaginal hemorrhage circumstances, he added.
A future Baylor Research Institute study, now in enrollment, could determine if below-freezing temperatures also work on women who require a C-section after spending hours in labor without success. This is the so-called “tired uterus” effect. “We want to analyze those patients who have had a dysfunctional labor experience to see if the cold is as effective on a uterus that has been working all day as opposed to one that hasn’t gone through an all-day labor,” Dr. Stecher said.
Keeping Dreams Possible
If future investigations corroborate this pilot study’s findings, it could shift the way babies are delivered, potentially helping the 3 percent to 6 percent of women who suffer from postpartum hemorrhage. Up to 80 percent of postpartum bleeding is caused by uterine atony. “It is my hope to defeat uterine atony before I retire…sometime in the distant future,” Dr. Stecher said.
Dr. Mitchell will present her manuscript at the ACOG annual meeting in San Francisco, where the paper was recognized as the best resident-submitted entry. As news of the study spreads at ACOG and beyond, researchers hope the study’s results will launch serious consideration into uterine cooling for women with postpartum hemorrhage.
“Studying the effects of cold on the body and its ability to minimize blood loss during surgery could one day revolutionize patient care,” Crowson said. “Imagine the woman who dreams of having multiple children and after delivering her first child, is forced to have a hysterectomy to stop postpartum bleeding. I want to find a way to keep this dream, and others, possible.”