T F Burke1,2, R Ahn1,2, B D Nelson1,2, R Hines1, J Kamara1, M Oguttu3, L Dulo3, E Achieng3, B Achieng3, A Natarajan1,2, J Maua4, Sas Kargbo5, Z Altawil1, K Tester1, E de Redon1, M Niang6, K Abdalla7, M J Eckardt1,8. 1. Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA. 2. Harvard Medical School, Boston, MA, USA. 3. Kisumu Medical and Education Trust, Kisumu, Kenya. 4. Division of Reproductive and Maternal Health, Ministry of Health, Nairobi, Kenya. 5. Division of Reproductive Health, Ministry of Health and Sanitation, Freetown, Sierra Leone. 6. Centre de Formation et de Recherche en Santé de la Reproduction, Dakar, Senegal. 7. UNICEF, Nairobi, Kenya. 8. Department of Obstetrics and Gynecology, Boston Medical Center, Boston, MA, USA.
Abstract
OBJECTIVE: To evaluate the effectiveness and safety of an ultra-low-cost uterine balloon tamponade package (ESM-UBT™) 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. TWEETABLE ABSTRACT: Evidence for ESM-UBT as a clinically promising and safe method to arrest uncontrolled PPH and save women's lives.
OBJECTIVE: To evaluate the effectiveness and safety of an ultra-low-cost uterine balloon tamponade package (ESM-UBT™) 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. TWEETABLE ABSTRACT: Evidence for ESM-UBT as a clinically promising and safe method to arrest uncontrolled PPH and save women's lives.
Authors: Abirami Natarajan; Anna Alaska Pendleton; Brett D Nelson; Roy Ahn; Monica Oguttu; Lidu Dulo; Melody J Eckardt; Thomas F Burke Journal: Int J Gynaecol Obstet Date: 2016-07-27 Impact factor: 3.561
Authors: H A Anger; R Dabash; J Durocher; N Hassanein; S Ononge; L J Frye; A Diop; S B Beye; G Burkhardt; E Darwish; M C Ramadan; J Kayaga; D Charles; A Gaye; M Eckardt; B Winikoff Journal: BJOG Date: 2019-09-18 Impact factor: 6.531
Authors: Anna Alaska Pendleton; Abirami Natarajan; Roy Ahn; Brett D Nelson; Melody J Eckardt; Thomas F Burke Journal: BMJ Open Date: 2016-01-08 Impact factor: 2.692
Authors: Alexandre Dumont; Cécile Bodin; Benjamin Hounkpatin; Thomas Popowski; Mamadou Traoré; René Perrin; Patrick Rozenberg Journal: BMJ Open Date: 2017-09-01 Impact factor: 2.692
Authors: Jennifer Makin; Daniela I Suarez-Rebling; Poonam Varma Shivkumar; Vincent Tarimo; Thomas F Burke Journal: Case Rep Obstet Gynecol Date: 2018-06-03