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

Cebekhulu, Sylvia; Abdul, Hazmath; Batting, Joanne; Chauke, Lawrence; Dlakavu, Fuziwe; Fawcus, Sue; Govender, Logie; Majeke, Busiwe; Mbongozi, Xolani; Singata‐Madliki, Mandisa; Middleton, Katrin; Mlandu, Philiswa; Naidoo, Poovangela; Ndaba, Sanele; Soma-Pillay, Priya; Spence, Trevi; Ntambua, Symphorien C.; Hofmeyr, Justus

doi:10.1002/ijgo.13963

Cited by 7 publications

(3 citation statements)

References 21 publications

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“…Celox and the modified Bakri had no available published studies conducted in an LMIC setting, and only the Levin gastric tube had a reported randomised controlled trial in process. 24 There was no standardised primary outcome in the 14 studies reviewed.…”

Section: Bmj Public Healthmentioning

confidence: 99%

Global research priorities for intrauterine suction and sponge tools for postpartum haemorrhage management in low-income and middle-income countries: a modified Delphi approach

Walker,

Shin,

Santos

et al. 2024

bmjph

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IntroductionPostpartum haemorrhage (PPH) remains the leading cause of maternal mortality and morbidity globally. Innovative PPH management tools have emerged using suction and sponge tamponade but currently lack substantial evidence. Broader understanding and collaborative research prioritisation are needed, especially in low-income and middle-income countries (LMICs), where the burden of PPH-related mortality is highest. We aimed to describe the current state of evidence and to solicit stakeholder input to identify research priorities related to emerging tools for PPH management.MethodsWe used a four-phase modified Delphi approach to identify research priorities for emerging suction and sponge tools. In phase 1, we conducted a literature review and key informant interviews (KIIs) with 19 stakeholders. In phase 2, we distributed an online survey, receiving 66 responses. In phase 3, we virtually convened an expert panel of stakeholders (n=24) and a separate midwife-only focus group to discuss preliminary results and draft research questions. In phase 4, we surveyed our expert panel (n=37) for prioritisation of research questions. Surveys were disseminated via Research Electronic Data Capture while KIIs and the expert convening were held virtually.ResultsParticipants included clinicians, researchers, policy-makers, funders and tool developers from high-income and LMIC settings. The prioritisation process narrowed our focus from six tools to four, all of which were top-ranked priorities in phase 4. Stakeholders emphasised efficacy research in comprehensive emergency obstetric and newborn care facilities. Stakeholders stressed the importance of understanding adverse event risks. The urgency in conducting research on cost, provider ease of use and acceptability and patient experience differed between individuals from high-income versus LMIC settings.ConclusionAll four tools prioritised in this process have the potential to improve PPH management in LMICs. A coordinated research agenda is necessary to confirm safety and efficacy and to determine which tools are most appropriate for specific LMIC settings.

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Section: Bmj Public Healthmentioning

confidence: 99%

Global research priorities for intrauterine suction and sponge tools for postpartum haemorrhage management in low-income and middle-income countries: a modified Delphi approach

Walker,

Shin,

Santos

et al. 2024

bmjph

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“…Improvised use of a Bakri balloon catheter as a suction catheter is in routine use at the University Hospital, Zurich, Switzerland [ 40 ]. Use of an inexpensive Levin stomach tube FG 24 to 36 for ‘suction tube uterine tamponade’ has been reported [ 41 , 42 ].…”

Section: Uterine Suction Tamponadementioning

confidence: 99%

Novel concepts and improvisation for treating postpartum haemorrhage: a narrative review of emerging techniques

Hofmeyr¹

2023

Reprod Health

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Background Most treatments for postpartum haemorrhage (PPH) lack evidence of effectiveness. New innovations are ubiquitous but have not been synthesized for ready access. Narrative review Pubmed 2020 to 2021 was searched on ‘postpartum haemorrhage treatment’, and novel reports among 755 citations were catalogued. New health care strategies included early diagnosis with a bundled first response and home-based treatment of PPH. A calibrated postpartum blood monitoring tray has been described. Oxytocin is more effective than misoprostol; addition of misoprostol to oxytocin does not improve treatment. Heat stable carbetocin has not been assessed for treatment. A thermostable microneedle oxytocin patch has been developed. Intravenous tranexamic acid reduces mortality but deaths have been reported from inadvertent intrathecal injection. New transvaginal uterine artery clamps have been described. Novel approaches to uterine balloon tamponade include improvised and purpose-designed free-flow (as opposed to fixed volume) devices and vaginal balloon tamponade. Uterine suction tamponade methods include purpose-designed and improvised devices. Restrictive fluid resuscitation, massive transfusion protocols, fibrinogen use, early cryopreciptate transfusion and point-of-care viscoelastic haemostatic assay-guided blood product transfusion have been reported. Pelvic artery embolization and endovascular balloon occlusion of the aorta and pelvic arteries are used where available. External aortic compression and direct compression of the aorta during laparotomy or aortic clamping (such as with the Paily clamp) are alternatives. Transvaginal haemostatic ligation and compression sutures, placental site sutures and a variety of novel compression sutures have been reported. These include Esike’s technique, three vertical compression sutures, vertical plus horizontal compression sutures, parallel loop binding compression sutures, uterine isthmus vertical compression sutures, isthmic circumferential suture, circumferential compression sutures with intrauterine balloon, King’s combined uterine suture and removable retropubic uterine compression suture. Innovative measures for placenta accreta spectrum include a lower uterine folding suture, a modified cervical inversion technique, bilateral uterine artery ligation with myometrial excision of the adherent placenta and cervico-isthmic sutures or a T-shaped lower segment repair. Technological advances include cell salvage, high frequency focussed ultrasound for placenta increta and extra-corporeal membrane oxygenation. Conclusions Knowledge of innovative methods can equip clinicians with last-resort options when faced with haemorrhage unresponsive to conventional methods.

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“…Another approach to generate intrauterine vacuum tamponade involves using a Levin stomach tube (FG24 or FG36), which has an open end and 4 side ports near the open tip. [12][13][14] The Levin stomach tube is low cost and has many favorable design features, including a rounded tip, wide-bore, and circumferentially placed side ports. The FG36 Levin stomach tube is 12 mm in diameter and has 10 mm side ports.…”

Section: Novel Approaches To Generating An Intrauterine Vacuum To Tre...mentioning

confidence: 99%

Intrauterine vacuum device treatment of postpartum hemorrhage

Barbieri

2023

OBGM

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

Cited by 7 publications

References 21 publications

Global research priorities for intrauterine suction and sponge tools for postpartum haemorrhage management in low-income and middle-income countries: a modified Delphi approach

Global research priorities for intrauterine suction and sponge tools for postpartum haemorrhage management in low-income and middle-income countries: a modified Delphi approach

Novel concepts and improvisation for treating postpartum haemorrhage: a narrative review of emerging techniques

Intrauterine vacuum device treatment of postpartum hemorrhage

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