A qualitative assessment of the impact of a uterine balloon tamponade package on decisions regarding the role of emergency hysterectomy in women with uncontrolled postpartum haemorrhage in Kenya and Senegal

Abstract

ObjectivesTo assess the impact of a every second matters for mothers and babies uterine balloon tamponade package (ESM-UBT) on provider decisions regarding emergency hysterectomy in cases of uncontrolled postpartum haemorrhage (PPH).DesignQualitative assessment and analysis of a subgroup extracted from a larger database that contains all UBT device uses among ESM-UBT trained health providers.SettingHealth facilities in Kenya and Senegal with ESM-UBT training and capable of performing emergency hysterectomies.ParticipantsAll medical doctors who had placed a UBT for uncontrolled PPH subsequent to implementation of ESM-UBT at their facility, and who also had the capabilities of performing emergency hysterectomies.Primary outcome measuresThe impact of ESM-UBT on decisions regarding emergency hysterectomy in cases of uncontrolled PPH.Results30 of the 31 medical doctors (97%) who fulfilled the inclusion criteria were independently interviewed. Collectively the interviewed medical doctors had placed over 80 UBT devices for uncontrolled PPH since ESM-UBT implementation. All 30 responded that UBT devices immediately controlled haemorrhage and prevented women from being taken to emergency hysterectomy. All 30 would continue to use UBT devices in future cases of uncontrolled PPH.ConclusionsThese preliminary data suggest that following ESM-UBT implementation, emergency hysterectomy for uncontrolled PPH may be averted by use of uterine balloon tamponade.

Time for global scale‐up, not randomized trials, of uterine balloon tamponade for postpartum hemorrhage

“…Other evidence includes independently performed near‐miss surveys, impact and cost‐effectiveness studies, and the experiences of senior obstetricians’ and midwives’ in averting deaths and hysterectomies from their 14 countries and beyond (Table ). UBT has also influenced surgeons’ behavior by averting emergency hysterectomies . Overall, the evidence supports a high degree of efficacy of UBT use among women with PPH in low‐resource settings around the world.…”

Shock progression and survival after use of a condom uterine balloon tamponade package in women with uncontrolled postpartum hemorrhage

“…The objective of the present study was to better define the true impact of the ESM‐UBT package by specifically analyzing the outcomes of women in advanced stages of hemorrhagic shock—i.e. women who would typically be expected to have a high mortality rate …”

Time Determination of Permanence of the Sengstaken Blakemore Ballon in Relation with the Clinical Outcome in Postpartum Hemorrhage Patients

“…Other advantages that this method offers are avoiding laparotomy, easy and fast insertion and the fact that can be placed by low experienced personal the extraction is painless and offers a rapid way to evaluate the effectiveness of the balloon on failure attempts. As it is a simple procedure to make it can be made by First Level of Attention personal before referring a patient to another unit, once the SBB Uterine tamponade is placed, it will minimize blood loss and will avoid irreversible shock and mortality [3,4]. The condom associated to a catheter (Bangladesh) adjusts naturally to the uterine form and exercises a uniform pressure over the venous sinuses in the uterine vasculature which stops the hemorrhage.…”

“…Rajni Lohano et al [1], informed success rate of 90.4% for the control of postpartum hemorrhage with condom associated to a catheter (BANGLADESH) [3]. Alaska Pendleton et al [4] designed and implemented a kit in Kenya, consisting of a syringe, Luer closing valve and a condom strapped at the bottom of a Foley catheter with a cotton thread, the device can be inflated with any solution throughout a syringe of 60 ml and is inserted to the uterine cavity. The kit includes a 3 hours training of the management of PPH.…”