An inexpensive device to treat postpartum hemorrhage: a preliminary proof of concept study of health provider opinion and training in Nepal

Abstract

BackgroundObstetric hemorrhage remains the leading cause of maternal mortality in resource limited areas. An inexpensive pneumatic anti-shock garment was devised of bicycle tubes and tailored cloth which can be prepared from local materials in resource-limited settings. The main purposes of this study were: 1) to determine acceptability of the device by nurses and midwives and obtain suggestions for making the device more suitable for use in their particular work environments, 2) to determine whether a three hour training course provided adequate instruction in the use of this device for the application of circumferential abdominal pelvic pressure, and 3) determine production capability and cost in a resource-limited country.MethodsFifty-eight nurse and midwife participants took part in three sessions over eight months in Nepal. Correct device placement was assessed on non-pregnant participants using ultrasound measurement of distal aortic flow before and after device inflation, and analyzed using confidence intervals. Participants were surveyed to determine acceptability of the device, obtain suggestions for improvement, and to collect data on clinical use.ResultsDevice placement achieved flow decreases with a mean of 39% (95% CI 25%-53%, p < 0.001) in the first session, 28% (95% CI 21%-33%, P < 0.001) after four months and 29% (95% CI 24%-34%, p < 0.001) at 8 months. All nurses and midwives thought the device would be acceptable for use in obstetric hemorrhage and that they could make, clean, and apply it. They quickly learned to apply the device, remembered how to apply it, and were willing and able to use the device clinically. Ten providers used the device, each on one patient, to treat obstetric hemorrhage after routine measures had failed; bleeding stopped promptly in all ten, two of whom were transported to the hospital. Production of devices in Kathmandu using local tailors and supplies cost approximately $40 per device, in a limited production setting.ConclusionsPreliminary data suggest that an inexpensive, easily-made device is potentially an appropriate addition to current obstetric hemorrhage treatment in resource-limited areas and that further study is warranted.

Obstetric hemorrhage in resource‐limited locations: A quality improvement project after adoption of abdominopelvic compression devices

“…An initial group of 58 providers was trained in 2010 to use the prototype bicycle tube device. These were used 10 times with good results, as previously reported 17 . Providers continued to use the device after the initial study and, in 2017, an additional 74 providers were trained using the Ball and Binder version.…”

“…The prototype three‐compartment device was used 28 times in Nepal in addition to the 10 cases previously reported 17 . Devices with only an abdominal compartment were used 40 times in Nepal (10 using the soccer ball) and 28 times in PNG (all using the soccer ball).…”

Global Emergency Medicine: A Review of the Literature From 2014

“…The top 25 global EM articles for 2014 are listed in Table . The complete database of all 477 global EM articles for 2014, as well as full summaries and critical analyses of the top 25 global EM articles of 2014 can be found in Data Supplements S1 and S2 (available as supporting information in the online version of this article).…”

“…Postpartum hemorrhage is the leading cause of maternal mortality worldwide and a concern for public health practitioners and acute care providers alike, particularly in areas where definitive obstetric care may be delayed or unavailable. Kerr et al . report on a proof‐of‐concept study evaluating a novel, inexpensive, pneumatic antishock garment made of bicycle tire tubes and locally available cloth for the treatment of postpartum hemorrhage.…”

Empowering midwives to manage postpartum haemorrhage in rural areas of Islamic Republic of Iran: lessons learnt from cases of maternal death

“…In low-and middleincome countries, postpartum haemorrhage mortality is high (5,8). Previous studies have shown that treatment is most effective if started promptly (9). In 80% of cases of postpartum haemorrhage, women receive substandard care (10), underestimation of blood loss, delayed diagnosis and management of haemorrhage treatment failures (11), lack of easy-to-use local protocols (active management of the third stage of labour), lack of adequate education and training, and poor communication.…”