Healthcare providers experiences of using uterine balloon tamponade (UBT) devices for the treatment of post-partum haemorrhage: A meta-synthesis of qualitative studies

Abstract

Background Postpartum haemorrhage (PPH) is a leading cause of maternal mortality and severe morbidity globally. When PPH cannot be controlled using standard medical treatments, uterine balloon tamponade (UBT) may be used to arrest bleeding. While UBT is used by healthcare providers in hospital settings internationally, their views and experiences have not been systematically explored. The aim of this review is to identify, appraise and synthesize available evidence about the views and experiences of healthcare providers using UBT to treat PPH. Methods Using a pre-determined search strategy, we searched MEDLINE, CINAHL, PsycINFO, EMBASE, LILACS, AJOL, and reference lists of eligible studies published 1996–2019, reporting qualitative data on the views and experiences of health professionals using UBT to treat PPH. Author findings were extracted and synthesised using techniques derived from thematic synthesis and confidence in the findings was assessed using GRADE-CERQual. Results Out of 89 studies we identified 5 that met our inclusion criteria. The studies were conducted in five low- and middle-income countries (LMICs) in Africa and reported on the use of simple UBT devices for the treatment of PPH. A variety of cadres (including midwives, medical officers and clinical officers) had experience with using UBTs and found them to be effective, convenient, easy to assemble and relatively inexpensive. Providers also suggested regular, hands-on training was necessary to maintain skills and highlighted the importance of community engagement in successful implementation. Conclusions Providers felt that administration of a simple UBT device offered a practical and cost-effective approach to the treatment of uncontrolled PPH, especially in contexts where uterotonics were ineffective or unavailable or where access to surgery was not possible. The findings are limited by the relatively small number of studies contributing to the review and further research in other contexts is required to address wider acceptability and feasibility issues.

Successful use of condom catheters for management of uterine inversion: Case report and literature review

“…Bakrie balloons may be a solution but for developing countries, condom catheters can be used as an alternative. This situation is particularly effective when uterotonics are ineffective or unavailable or where access to surgery is not possible [9] . Table 1 shows the results of previous case reports discussing the successful use of condom catheters in the management of uterine inversion.…”

How inequity threatens the lives of pregnant women: barriers to accessing health services during an incomplete miscarriage in rural southern Mexico

“…For instance, the provision of a uterine balloon tamponade device and training of its use could represent a valuable asset in preforming a low-cost, non-invasive, life-saving procedure for postpartum haemorrhage in low-resource settings. 32 Furthermore, these health professionals should be trained and sensitised to adequately communicate a miscarriage and its cause to patients. Increasing basic medical information and providing basic psychoeducational support can help women avoid excessive feeling of responsibility and/or guilt following this event.…”

“Suction Tube Uterine Tamponade” for treatment of refractory postpartum hemorrhage: Internal feasibility and acceptability pilot of a randomized clinical trial

“…Results from uncontrolled observational studies are compelling 5,6 . UBT has been promoted by global agencies and is positively viewed by providers 7 . It has become standard of care in many countries, including South Africa.…”

“…5,6 UBT has been promoted by global agencies and is positively viewed by providers. 7 It has become standard of care in many countries, including South Africa. However, an individually randomized 8 and a cluster-randomized trial 9 suggested more harm than benefit from UBT.…”