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Monitoring > PIERS On the Move

Background

In March 2011, Saving Lives At Birth: A Grand Challenge for Development (sponsored by USAID, Government of Norway, Bill & Melinda Gates Foundation, Grand Challenges Canada and the World Bank) launched a programme to find innovative prevention and treatment ideas for pregnant mothers and newborns in low resource settings.

Mark Ansermino and Peter von Dadelszen submitted a proposal entitled “PIERS On the Move: Pre-eclampsia Integrated Estimate of RiSk assessment” on a mobile phone on behalf of a team in UBC Pediatric Anesthesiology and Electrical and Computer Engineering, and their colleagues at Stellenbosch University, South Africa.

Mark Ansermino, Guy Dumont, and Peter von Dadelszen are leading PIERS on the Move (POM), in conjunction with their colleagues at Stellenbosch University in South Africa.

Goal

The objective is to develop the PIERS Phone Oximeter, a portable, low-cost device that will rapidly and reliably identify women and babies at increased risk of adverse outcomes from pre-eclampsia.

This technological solution integrates two successful innovations: the PIERS predictive probability and the Phone Oximeter, to overcome the barriers produced by insufficient training, distances to healthcare facilities and unavailability of resources in LMICs. The prediction of adverse maternal outcomes in pre-eclampsia is a based on symptoms and clinical signs, including a low blood oxygen saturation level that can be measured with the Phone Oximeter.

Recent Progress

The clinical validation study began recruiting subjects at Tygerberg Hospital in Cape Town, South Africa in October 2012. In this clinical study, our objective is to determine if the POM tool correctly identifies women who are at high and low risk of adverse maternal outcomes due to pre-eclampsia. Women deemed at high risk will be those that go on to develop one or more component of the miniPIERS adverse maternal outcomes.  We plan to recruit 300 women with suspected or confirmed pre-eclampsia by November 2013.

POM team members travelled to Frere Maternity Hospital in East London, South Africa in January 2013 to conduct the next round of usability testing with midwives and nurses.  This successful trip completed data collection with over 20 subjects with great feedback from the users to enable the software team to further refine the application.
 A new simplified version of POM has been created for the CLIP Definitive trial.  The development team in Vancouver has modified the original POM application to be used by the cHCPs in the CLIP Definitive trial.  This version of POM does not include laboratory tests but is mainly symptom and sign-based.

Unfortunately, the Transition to Scale application to the 2013 Saving Lives at Birth grant competition was unsuccessful. The team is still committed to finding other sources of funding to undertake a randomized controlled trial evaluating the benefit of pulse oximetry as a component of the PIERS model.

Anticipated Deliverables

Data collection through the first POM seed grant project was concluded in November 2013. Two manuscripts resulting from this activity have now been submitted for publication. The first manuscript details results of the usability testing of the POM app with midwives in South Africa. The second publication describes the impact of inclusion of pulse oximetry as a novel biomarker in the miniPIERS model.

As a result of successful application for additional funding through Round 4 of the Saving Lives at Birth grant competition, continuation of this important work will be possible. Next steps will include development of prediction models to better define maternal risk due to postpartum hemorrhage and obstetric sepsis along with defining childhood risks through development of prediction models for pneumonia and other common causes of neonatal death and stillbirth. This work will be possible through partnership with the Aga Khan Development Network.