World Health Organization Recommendation for Using Uterine Balloon Tamponade to Treat Postpartum Hemorrhage

Weeks, Andrew; Akinola, Oluwarotimi Ireti; Amorim, Melânia Maria Ramos; Carvalho, Brendan; Deneux‐Tharaux, Catherine; Liabsuetrakul, Tippawan; Meremikwu, Martin; Miller, Suellen; Nabhan, Ashraf; Nagai, Moritaka; Wahabi, Hayfaa; Walker, Dilys

doi:10.1097/aog.0000000000004674

Cited by 14 publications

(14 citation statements)

References 13 publications

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“…Тому всіх вагітних жінок слід вважати групою ризику ППК. Поширені причини включають атонію матки, затримку плаценти, травму пологових шляхів та коагулопатію [2, 7,11].…”

Section: мета дослідження оцінити ефективність комплексного лікування...unclassified

“…У травні 2021 року Всесвітня організація охорони здоров'я (ВООЗ) опублікувала оновлені рекомендації щодо використання балонної тампонади матки для лікування післяпологових кровотеч [7]. Нова рекомендація ВООЗ викликала занепокоєння про те, що використання балонної тампонади матки рекомендовано лише в ситуаціях, коли доступна стандартна допомога при післяпологових кровотечах, включаючи хірургічне втручання та переливання крові.…”

Section: мета дослідження оцінити ефективність комплексного лікування...unclassified

“…Група розробки настанов ВООЗ розробила рекомендації, що залежать від контексту, в яких зазначено, що балонна тампонада матки рекомендована для лікування післяпологової кровотечі внаслідок атонії матки після вагінальних пологів у жінок, які не відповідають на стандартне лікування першої лінії, за умови дотримання наступних умов: негайного хірургічного втручання та отримання препаратів крові [7].…”

Section: мета дослідження оцінити ефективність комплексного лікування...unclassified

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Intrauterine Balloon Tamponade as an Effective Method of Conservative Treatment of Postpartum Bleeding

Posokhova¹,

Honta²,

Riazantsev³

et al. 2022

AAGU

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Postpartum haemorrhage (PPH) is the leading cause of maternal mortality worldwide and accounts for approximately a quarter of all maternal deaths today. In May 2021, the World Health Organization (WHO) published updated recommendations that intrauterine balloon tamponade is an effective treatment for postpartum hemorrhage when first-line treatment is ineffective. The implementation of balloon intrauterine tamponade during postpartum hemorrhage after cesarean section appears to be safe and effective, which contributes to the reduction of both invasive procedures and the frequency of transfusions. Objective of the study To evaluate the effectiveness of the complex treatment of hypotonic postpartum hemorrhage and bleeding with placental abruption or placentaaccreta during cesarean section by using intrauterine balloon tamponade to prevent periportal hysterectomy. Methods An analysis of 30 cases of postpartum bleeding, which were treated with intrauterine balloon tamponade (IBT), and ended with effective conservative treatment without hysterectomy, was conducted. Research results and their discussion Parity of childbirth is important as a risk factor for the occurrence of hypotonic bleeding. A stretched uterus due to a large fetus was present in 4 (13.3%), twins - in 3 (10%), polyhydramnios - in 2 (6.6%), that is, every third woman had such a risk factor for bleeding. The course of childbirth plays an important role in the exhaustion of the contractile activity of the uterus and the occurrence of postpartum bleeding. Massive obstetric bleeding was more than 1.5% of the weight in 3 (13.6%) women, up to 1.5% in 17 (77.2%), up to 1% in 2 (9.2%). Intrauterine balloon tamponade was performed for the treatment of PPK after ineffective first-line measures. According to our data, finding an intrauterine balloon gradually stopped the bleeding. 1 hour after UBT of the uterus, the amount of blood loss decreased to 400 ml per hour, gradually decreasing to 4-6 hours. After 6 hours of VBT being in the uterus, the bleeding was stopped and the volume of circulating blood was restored. Conclusions Thus, women who have a history of massive postpartum bleeding, multiparous women, pregnant women with a stretched uterus due to a large fetus, multiple pregnancy, women who give birth with a violation of the contractile activity of the uterus are a risk group for the occurrence of postpartum bleeding. Intrauterine balloon tamponade is an effective method of conservative treatment of postpartum bleeding, which should be widely used in obstetric practice.

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Section: мета дослідження оцінити ефективність комплексного лікування...unclassified

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Intrauterine Balloon Tamponade as an Effective Method of Conservative Treatment of Postpartum Bleeding

Posokhova¹,

Honta²,

Riazantsev³

et al. 2022

AAGU

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“…In 2021, WHO published a new recommendation on the use of UBTs for treatment of PPH due to uterine atony after vaginal birth in women who do not respond to first-line treatments 30 31. The recommendation further states that UBTs should be used only where access to other PPH treatments and supportive systems is already in place.…”

Section: Introductionmentioning

confidence: 99%

Introduction of the Ellavi uterine balloon tamponade into the Kenyan and Ghanaian maternal healthcare package for improved postpartum haemorrhage management: an implementation research study

Parker

Qureshi

Deganus³

et al. 2023

BMJ Open

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ObjectivesUse of intrauterine balloon tamponades for refractory postpartum haemorrhage (PPH) management has triggered recent debate since effectiveness studies have yielded conflicting results. Implementation research is needed to identify factors influencing successful integration into maternal healthcare packages. The Ellavi uterine balloon tamponade (UBT) (Ellavi) is a new low-cost, preassembled device for treating refractory PPH.DesignA mixed-methods, prospective, implementation research study examining the adoption, sustainability, fidelity, acceptability and feasibility of introducing a newly registered UBT. Cross-sectional surveys were administered post-training and post-use over 10 months.SettingThree Ghanaian (district, regional) and three Kenyan (levels 4–6) healthcare facilities.ParticipantsObstetric staff (n=451) working within participating facilities.InterventionPPH management training courses were conducted with obstetric staff.Primary and secondary outcome measuresFacility measures of adoption, sustainability and fidelity and individual measures of acceptability and feasibility.ResultsAll participating hospitals adopted the device during the study period and the majority (52%–62%) of the employed obstetric staff were trained on the Ellavi; sustainability and fidelity to training content were moderate. The Ellavi was suited for this context due to high delivery and PPH burden. Dynamic training curriculums led by local UBT champions and clear instructions on the packaging yielded positive attitudes and perceptions, and high user confidence, resulting in overall high acceptability. Post-training and post-use, ≥79% of the trainees reported that the Ellavi was easy to use. Potential barriers to use included the lack of adjustable drip stands and difficulties calculating bag height according to blood pressure. Overall, the Ellavi can be feasibly integrated into PPH care and was preferred over condom catheters.ConclusionsThe training package and time saving Ellavi design facilitated its adoption, acceptability and feasibility. The Ellavi is appropriate and feasible for use among obstetric staff and can be successfully integrated into the Kenyan and Ghanaian maternal healthcare package.Trial registration numbersNCT04502173;NCT05340777.

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“…2,3 However, in 2021, the World Health Organization published its updated guidelines and recommended the use of balloon intrauterine tamponade only for situations where standard care for postpartum hemorrhage (including surgical intervention and blood transfusion) is accessible. 13,14 Given this recommendation, an understanding of the factors associated with intrauterine tamponade failure is needed.…”

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confidence: 99%

Risk Factors for Intrauterine Tamponade Failure in Postpartum Hemorrhage

Gibier

Pauly

Orléans

et al. 2022

Obstetrics &Amp; Gynecology

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To identify factors associated with intrauterine tamponade failure after vaginal or cesarean delivery.METHODS: This was a nationwide population-based cohort study that used data from the French Programme de Me ´dicalisation des Syste `mes d'Information. This study compared the failure and effectiveness of intrauterine tamponade among all women who received the procedure in France from January 1, 2019, to December 31, 2019. Failure was defined as the use of a second-line method (uterine artery embolization, conservative or radical surgery, or death) within 7 days of intrauterine tamponade. Factors associated with intrauterine tamponade failure were identified by univariate analyses and tested using multivariate generalized logistic regression models (with a random intercept on institution) to obtain adjusted odds ratio (aOR) and 95% CI statistics.

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World Health Organization Recommendation for Using Uterine Balloon Tamponade to Treat Postpartum Hemorrhage

Abstract: The World Health Organization recommends that balloon tamponade should be used only where other supportive interventions are available if needed.

Cited by 14 publications

References 13 publications

Intrauterine Balloon Tamponade as an Effective Method of Conservative Treatment of Postpartum Bleeding

Intrauterine Balloon Tamponade as an Effective Method of Conservative Treatment of Postpartum Bleeding

Introduction of the Ellavi uterine balloon tamponade into the Kenyan and Ghanaian maternal healthcare package for improved postpartum haemorrhage management: an implementation research study

Risk Factors for Intrauterine Tamponade Failure in Postpartum Hemorrhage

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