A postpartum haemorrhage package with condom uterine balloon tamponade: a prospective multi‐centre case series in Kenya, Sierra Leone, Senegal, and Nepal

Abstract

Objective To evaluate the effectiveness and safety of an ultra-lowcost uterine balloon tamponade package (ESM-UBTTM) for facility-based management of uncontrolled postpartum haemorrhage (PPH) in Kenya, Sierra Leone, Senegal, and Nepal.Design Prospective multi-centre case series.Setting Facilities in resource-scarce areas of Kenya, Sierra Leone, Nepal, and Senegal.Population Women with uncontrolled postpartum haemorrhage in 307 facilities across the four countries.Methods A standardised ESM-UBT package was implemented in 307 facilities over 29 months (1 September 2012 to 1 February 2015. Data were collected via a multi-pronged approach including data card completion, chart reviews, and provider interviews. Beginning in August 2014, women who had previously undergone UBT placement were sought and queried regarding potential complications associated with UBT use.Main outcome measures All-cause survival, survival from PPH, and post-UBT use complications (surgery, hospitalisation, antibiotics for pelvic infection) associated with UBT use.Results 201 UBTs were placed for uncontrolled vaginal haemorrhage refractory to all other interventions. In all, 38% (71/ 188) of women were either unconscious or confused at the time of UBT insertion. All-cause survival was 95% (190/201). However, 98% (160/163) of women survived uncontrolled PPH if delivery occurred at an ESM-UBT online facility. One (1/151) potential UBT-associated complication (postpartum endometritis) was identified and two improvised UBTs were placed in women with a ruptured uterus.Conclusions These pilot data suggest that the ESM-UBT package is a clinically promising and safe method to arrest uncontrolled postpartum haemorrhage and save women's lives. The UBT was successfully placed by all levels of facility-based providers. Future studies are needed to further evaluate the effectiveness of ESM-UBT in low-resource settings.Keywords Maternal mortality, postpartum haemorrhage, uterine balloon tamponade. Please cite this paper as: Burke TF, Ahn R, Nelson BD, Hines R, Kamara J, Oguttu M, Dulo L, Achieng E, Achieng B, Natarajan A, Maua J, Kargbo SAS, Altawil Z, Tester K, de Redon E, Niang M, Abdalla K, Eckardt MJ. A postpartum haemorrhage package with condom uterine balloon tamponade: a prospective multi-centre case series in Kenya, Sierra Leone, Senegal, and Nepal. BJOG 2016;123:1532-1540

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

“…When hemorrhage persists, alternative methods are often used, including aortic compression, uterine balloon tamponade (UBT), non‐pneumatic antishock trousers, and surgical interventions such as uterine artery embolization, B‐Lynch compression suturing, and ultimately hysterectomy . In low‐resource settings, access to surgical services is limited or nonexistent; thus, women with uncontrolled hemorrhage often die or become disabled …”

“…During the past 8 years, an evidence‐based PPH package using an ultra‐low‐cost condom‐based uterine balloon called Every Second Matters for Mothers and Babies UBT (ESM‐UBT; Massachusetts General Hospital, Boston, MA, USA) has been designed, developed, implemented, and refined . The ESM‐UBT package—which consists of the UBT device, a PPH clinical management checklist, and a training module—has been successfully implemented across all levels of the health systems in Ghana, Kenya, Nepal, Senegal, Sierra Leone, South Sudan, Tanzania, and Zambia.…”

Systematic review to identify proxy indicators to quantify the impact of eHealth tools on maternal and neonatal health outcomes in low-income and middle-income countries including Delphi consensus

“…91 Three studies suggest that condom catheter uterine balloon tamponade (C-UBT) is simple to use, inexpensive, safe and may be used by any healthcare provider involved in delivery for controlling massive PPH. [92][93][94] neonatal care Interventions for all neonates include hygienic care, prevention of hypothermia, support for immediate breast feeding and prophylactic vitamin K.…”

Innovative Uses of Condom Uterine Balloon Tamponade for Postpartum Hemorrhage in India and Tanzania

“…Since then, commercial UBT devices have become available for use in atonic postpartum hemorrhage; however they are often unaffordable in resource limited settings. Over the past eight years the authors have designed, implemented, refined, and studied [5, 6] an evidence-based package called Every Second Matters for Mothers-UBT (ESM-UBT). The ESM-UBT is a simple innovation that consists of a condom fastened to a 24 French Foley catheter by string.…”