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Piaggio D, Hyland S, Maccaro A, Iadanza E, Pecchia L. A 3D-printed condom intrauterine balloon tamponade: Design, prototyping, and technical validation. PLoS One 2024; 19:e0303844. [PMID: 38861495 PMCID: PMC11166290 DOI: 10.1371/journal.pone.0303844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/01/2024] [Indexed: 06/13/2024] Open
Abstract
Post-partum haemorrhage is among the main causes of (preventable) mortality for women in low-resource settings (LRSs), where, in 2017, the mortality ratio was 462 out of every 100 000 live births, over 10 times higher than for high-resource settings. There are different treatments available for post-partum haemorrhage. The intrauterine balloon tamponade is a medical device that proved to be a simple and cost-effective approach. Currently, there are several balloon tamponades available, with different design and working principles. However, all these devices were designed for high-resource settings, presenting several aspects that could be inappropriate for many lower-income countries. This paper presents the results of a preclinical study aiming at informing the design, prototyping and validation of a 3D-printed intrauterine balloon tamponade concept, contributing towards the United Nation's Sustainable Development Goal 3: Good health and Well-being. Frugal engineering concepts and contextualised design techniques were applied throughout, to define the design requirements and specifications. The performance of the final prototype was validated against the requirements of the UK National Health System (NHS) technical guidelines and relevant literature, measuring the water leak and pressure drop over time, both open air and in a approximate uterus model. The resulting prototype is made up of six components, some of which are easy to retrieve, namely a water bottle, a silicone tube and an ordinary condom, while others can be manufactured locally using 3D printers, namely a modified bottle cap, a flow stopper and a valve for holding the condom in place. Validation testing bore promising results with no water or pressure leak open air, and minimal leaks in the approximate uterus model. This demonstrates that the 3D printed condom-based intrauterine balloon tamponade is performing well against the requirements and, when compared to the state of the art, it could be a more appropriate and more resilient solution to low-resource settings, as it bypasses the challenges in the supply of consumables and presents a greener option based on circular economy.
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Affiliation(s)
- Davide Piaggio
- School of Engineering, University of Warwick, Coventry, United Kingdom
| | - Scott Hyland
- School of Engineering, University of Warwick, Coventry, United Kingdom
| | - Alessia Maccaro
- School of Engineering, University of Warwick, Coventry, United Kingdom
| | - Ernesto Iadanza
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Leandro Pecchia
- School of Engineering, University of Warwick, Coventry, United Kingdom
- School of Engineering, Campus Biomedico of Rome, Rome, Italy
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Germano C, Girlando F, Carosso AR, Messina A, Parpinel G, Leo L, Attini R, Revelli A, Masturzo B. Uterine Balloon Tamponade under Ultrasound Guidance in Women with Postpartum Hemorrhage: A Retrospective Cohort Study. J Clin Med 2024; 13:2632. [PMID: 38731162 PMCID: PMC11084657 DOI: 10.3390/jcm13092632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/15/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Postpartum hemorrhage (PPH) represents one of the principal causes of maternal mortality and morbidity worldwide. Uterine balloon tamponade (UBT) is recommended for the treatment of postpartum hemorrhage due to uterine atony in women who do not respond to pharmacological first-line treatment. The success of UBT in bleeding control is related to the correct positioning of the device, since incorrect insertion can be associated with ineffectiveness and requires time-consuming repositioning maneuvers, with a further increase in blood loss. The use of ultrasound (US) during UBT may increase the success rate by preventing wrong positioning. This study aims to demonstrate the role of US guidance during UBT and to assess whether US guidance can ease positioning and reduce insertion times, preventing additional repositioning maneuvers, in comparison with a US check carried out after balloon insertion. Methods: This was a retrospective study including 370 women who underwent vaginal delivery, had PPH caused by uterine atony and required UBT at Sant'Anna Hospital from 2015 to 2019. The exclusion criteria were an abnormal placental site, vaginal or cervical trauma, coagulation defects, uterine anomalies, previous postpartum hemorrhage and previous caesarean section. Included subjects were divided into two groups: the US-guided group (n = 200) underwent Bakri balloon positioning under US guidance, and the non-guided group (n = 170) received a US check only after balloon insertion. The primary outcome was the success rate of the procedure, expressed as the percentage of cases with bleeding control without the need for balloon repositioning; the secondary outcomes were the length of the procedure and some parameters related to blood loss. Results: The success rate was 99% for the US-guided group vs. 86% for the non-guided group. None of the patients required hysterectomy. In the US-guided group with respect to the non-guided group, we observed a significant reduction in blood loss (1100 ± 450 vs. 1500 ± 600 mL; p < 0.001), Δhemoglobin level (1.8 ± 1.1 vs. 2.7 ± 2.0 g/dL, p < 0.001) and time required for the procedure (8 vs. 13 min, p < 0.001). Conclusions: Our data suggest that the use of US guidance for placement of UBT was associated with reduced need for balloon repositioning, lower blood loss, and faster resolution of postpartum hemorrhage.
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Affiliation(s)
- Chiara Germano
- Department of Obstetrics and Gynecology, Nuovo Ospedale degli Infermi, 13875 Biella, Italy; (G.P.); (R.A.); (B.M.)
| | - Flavia Girlando
- SCDU2, Department of Surgical Sciences, Sant’Anna Hospital, University of Turin, 10126 Turin, Italy; (F.G.); (A.R.C.); (A.M.); (A.R.)
| | - Andrea Roberto Carosso
- SCDU2, Department of Surgical Sciences, Sant’Anna Hospital, University of Turin, 10126 Turin, Italy; (F.G.); (A.R.C.); (A.M.); (A.R.)
| | - Alessandro Messina
- SCDU2, Department of Surgical Sciences, Sant’Anna Hospital, University of Turin, 10126 Turin, Italy; (F.G.); (A.R.C.); (A.M.); (A.R.)
| | - Giulia Parpinel
- Department of Obstetrics and Gynecology, Nuovo Ospedale degli Infermi, 13875 Biella, Italy; (G.P.); (R.A.); (B.M.)
| | - Livio Leo
- Department of Obstetrics and Gynecology, Beauregard Hospital, 11100 Aosta, Italy;
| | - Rossella Attini
- Department of Obstetrics and Gynecology, Nuovo Ospedale degli Infermi, 13875 Biella, Italy; (G.P.); (R.A.); (B.M.)
| | - Alberto Revelli
- SCDU2, Department of Surgical Sciences, Sant’Anna Hospital, University of Turin, 10126 Turin, Italy; (F.G.); (A.R.C.); (A.M.); (A.R.)
| | - Bianca Masturzo
- Department of Obstetrics and Gynecology, Nuovo Ospedale degli Infermi, 13875 Biella, Italy; (G.P.); (R.A.); (B.M.)
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Escobar MF, Nassar AH, Theron G, Barnea ER, Nicholson W, Ramasauskaite D, Lloyd I, Chandraharan E, Miller S, Burke T, Ossanan G, Andres Carvajal J, Ramos I, Hincapie MA, Loaiza S, Nasner D. FIGO recommendations on the management of postpartum hemorrhage 2022. Int J Gynaecol Obstet 2022; 157 Suppl 1:3-50. [PMID: 35297039 PMCID: PMC9313855 DOI: 10.1002/ijgo.14116] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Maria Fernanda Escobar
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Anwar H Nassar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Gerhard Theron
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.,Tygerberg Hospital, Cape Town, South Africa
| | - Eythan R Barnea
- Society for Investigation or Early Pregnancy (SIEP), New York, New York, USA
| | - Wanda Nicholson
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Diana Ramasauskaite
- Center of Obstetrics and Gynecology, Vilnius University Medical Faculty, Vilnius, Lithuania
| | - Isabel Lloyd
- Department of Obstetrics and Gynecology, Universidad de Panamá, Panama City, Panamá.,Hospital Santo Tomas, Panama City, Panamá
| | - Edwin Chandraharan
- Department of Obstetrics and Gynecology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Suellen Miller
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Thomas Burke
- Division of Global Health and Human Rights, Massachusetts General Hospital, Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Harvard T.H. Chan School of Public Health, Boston, USA
| | - Gabriel Ossanan
- Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Javier Andres Carvajal
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Isabella Ramos
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Maria Antonia Hincapie
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Sara Loaiza
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Daniela Nasner
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
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- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia
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Burke TF, Shivkumar PV, Priyadarshani P, Garg L, Conde-Agudelo A, Guha M. Impact of the introduction of a low-cost uterine balloon tamponade (ESM-UBT) device for managing severe postpartum hemorrhage in India: A comparative before-and-after study. Int J Gynaecol Obstet 2022; 159:466-473. [PMID: 35212417 DOI: 10.1002/ijgo.14156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the impact of introducing a uterine balloon tamponade (ESM-UBT) device for managing severe postpartum hemorrhage (PPH), mainly due to uterine atony, in health facilities in India on the rates of PPH-related maternal death and invasive procedures for PPH control. METHODS We used a quasi-experimental, difference-in-difference (DID) design to compare changes in the rates of a composite outcome (PPH-related maternal death and/or artery ligation, uterine compression sutures, or hysterectomy) among women delivering in nine intervention facilities compared with those delivering in two control facilities, before and after the introduction of ESM-UBT. RESULTS The study sample included 214 123 deliveries (n = 78 509 before ESM-UBT introduction; n = 47 211 during ESM-UBT introduction; and n = 88 403 after ESM-UBT introduction). After introduction of ESM-UBT, there was a significant decline in the rate of the primary composite outcome in intervention facilities (21.0-11.4 per 10 000 deliveries; difference -9.6, 95% confidence interval -14.0 to -5.4). Change in the rate of the primary composite outcome was not significant in control facilities (11.7-17.2 per 10 000 deliveries; difference 5.4, 95% confidence interval -3.9 to 14.9). DID analyses showed there was a significant reduction in the rate of the primary composite outcome in intervention facilities relative to control facilities (adjusted DID estimate -15.0 per 10 000 points, 95% confidence interval -23.3 to -6.8; P = 0.005). CONCLUSION Introduction of the ESM-UBT in health facilities in India was associated with a significant reduction in PPH-related maternal death and/or invasive procedures for PPH control.
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Affiliation(s)
- Thomas F Burke
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Poonam V Shivkumar
- Department of Obstetrics and Gynecology, Mahatma Gandhi Institute of Medical Sciences, Sewagram, India
| | - Preeti Priyadarshani
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Gorakhpur, India
| | - Lorraine Garg
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Agustin Conde-Agudelo
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, US Department of Health and Human Services, National Institutes of Health, Bethesda, Maryland, USA
| | - Moytrayee Guha
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Brown School of Public Health, Providence, Rhode Island, USA
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Shetty SS, Moray KV, Chaurasia H, Joshi BN. Cost of managing atonic postpartum haemorrhage with uterine balloon tamponade devices in public health settings of Maharashtra, India: an economic microcosting study. BMJ Open 2021; 11:e042389. [PMID: 33653747 PMCID: PMC7929829 DOI: 10.1136/bmjopen-2020-042389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Postpartum haemorrhage (PPH) is the worldwide leading cause of preventable maternal mortality. India offers free treatment for pregnancy and related complications in its public health facilities. Management with uterine balloon tamponade (UBT) is recommended for refractory atonic PPH cases. As part of health technology assessment to determine the most cost-effective UBT device, this study estimated costs of atonic PPH management with condom-UBT, Every Second Matters (ESM) UBT and Bakri balloon UBT in public health system of Maharashtra, India. DESIGN Health system cost was estimated using primary economic microcosting, data from Health Management Information System and published literature for event probabilities. SETTINGS Four public health facilities from the state of Maharashtra, India representing primary, secondary and tertiary level care were chosen for primary costing. OUTCOME MEASURES Unit, package and annual cost of atonic PPH management with three UBT devices were measured. This included cost of medical treatment, UBT intervention and PPH related surgeries undertaken in public health system of Maharashtra for year 2017-2018. RESULTS Medical management of atonic PPH cost the health system US$37 (95% CI 29 to 45) per case, increasing to US$44 (95% CI 36 to 53) with condom-UBT and surgical interventions for uncontrolled cases. Similar cost was estimated for ESM-UBT. Bakri-UBT reported a higher cost of US$59 (95% CI 46 to 73) per case. Overall annual cost of managing 27 915 atonic PPH cases with condom-UBT intervention in Maharashtra was US$1 226 610 (95% CI 870 250 to 1 581 596). CONCLUSIONS Atonic PPH management in public health facilities of Maharashtra with condom-UBT, ESM-UBT or Bakri-UBT accounts to 3.8%, 3.8% or 5.2% of the state's annual spending on reproductive and child health services. These findings can guide policy-makers to include PPH complication management in publicly financed health schemes. Economic evaluation studies can use this evidence to determine cost effectiveness of UBT in Indian settings.
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Affiliation(s)
- Siddesh Sitaram Shetty
- Regional Resource Hub for Health Technology Assessment in India, Indian Council of Medical Research-National Institute for Research in Reproductive Health, Mumbai, India
| | - Kusum Venkobrao Moray
- Regional Resource Hub for Health Technology Assessment in India, Indian Council of Medical Research-National Institute for Research in Reproductive Health, Mumbai, India
| | - Himanshu Chaurasia
- Regional Resource Hub for Health Technology Assessment in India, Indian Council of Medical Research-National Institute for Research in Reproductive Health, Mumbai, India
| | - Beena Nitin Joshi
- Department of Operational Research, Indian Council of Medical Research-National Institute for Research in Reproductive Health, Mumbai, India
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Ramseyer AM, Lutgendorf MA. Implementation of Low-Cost Obstetric Hemorrhage Simulation Training Models for Resident Education. Mil Med 2020; 184:e637-e641. [PMID: 31038159 DOI: 10.1093/milmed/usz098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/11/2019] [Accepted: 04/09/2019] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Simulation is beneficial training for low frequency high acuity events such as management of obstetric hemorrhage. Our objective was to evaluate perceived competency in management of obstetric and pelvic hemorrhage following training with low fidelity task trainers using inexpensive and common medical supplies. MATERIALS AND METHODS This was a prospective observational study of training residents for management of obstetric and pelvic hemorrhage using a brief didactic instruction and low-cost task trainers with inexpensive common medical supplies. Participants practiced placement of a uterine tamponade balloon, uterine packing with gauze, pelvic parachute packing and temporary abdominal closure. Following training, participants completed a self-report survey regarding perceived competency with each technique. The Wilcoxon Signed-Rank Test was used to compare results before and after training. RESULTS Eighteen of 23 residents completed the training and completed the survey on perceived competencies. There was a statistically significant improvement in perceived competency for all participants before and after training, with scores improving by 1.5 points for Bakri placement, from 1.94 to 3.44 (p < 0.001), improving by 1.67 points for uterine packing, from 1.78 to 3.44 (p < 0.001), improving by 1.95 for pelvic parachute packing, from 1.16 to 3.11 (p < 0.001), and improving by 1.89 for temporary abdominal closure, from 1.22 to 3.11 (p < 0.001). CONCLUSIONS Low-cost supplies and task trainers can be utilized to simulate postpartum hemorrhage and improve perceived competency in managing obstetric and pelvic hemorrhage. Similar training programs can be used in small community programs with limited resources.
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Affiliation(s)
- Abigail M Ramseyer
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Littlerock, AK
| | - Monica A Lutgendorf
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Naval Medical Center San Diego, San Diego, CA
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Kerr NL, Hauswald M, Tamrakar SR, Kalit S. Obstetric hemorrhage in resource-limited locations: A quality improvement project after adoption of abdominopelvic compression devices. Int J Gynaecol Obstet 2020; 151:97-102. [PMID: 32614979 DOI: 10.1002/ijgo.13291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 02/22/2020] [Accepted: 06/01/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate obstetric hemorrhage outcomes and present data specific to adoption of pneumatic circumferential abdominopelvic compression devices. METHODS Two resource-limited locations added low-cost pneumatic compression devices to their standard protocols for obstetric hemorrhage between 2010 and 2019. Providers in rural Nepal and Papua New Guinea used devices that incorporated a bicycle tube or soccer ball ("Ball and Binder") to provide abdominopelvic pressure after all available routine treatments had failed. Data were collected during the entire period as part of ongoing obstetric quality improvement. Data presented include obstetric event, etiology of bleeding, need for surgery, transfusion, transport, length of transports, maternal survival, and complications. RESULTS Circumferential abdominopelvic compression was used 106 times. The devices were used primarily after vaginal birth with atony, but also for obstetrical lacerations, miscarriages, and post-abortion bleeding. In all cases the bleeding stopped "promptly." All women survived, none required hysterectomy, and no complications were reported resulting from device use. Only 15 (14%) patients were transported to a referral hospital. CONCLUSION In this quality improvement project, obstetric hemorrhage was controlled when circumferential pressure was applied after usual care had failed.
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Affiliation(s)
- Nancy L Kerr
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM, USA
| | - Mark Hauswald
- Department of Emergency Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Suman R Tamrakar
- Department of Gynecology and Obstetrics, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Solomon Kalit
- Department of Surgery, Porgera District Hospital, Porgera, Enga Province, Papua New Guinea
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Suarez S, Conde-Agudelo A, Borovac-Pinheiro A, Suarez-Rebling D, Eckardt M, Theron G, Burke TF. Uterine balloon tamponade for the treatment of postpartum hemorrhage: a systematic review and meta-analysis. Am J Obstet Gynecol 2020; 222:293.e1-293.e52. [PMID: 31917139 DOI: 10.1016/j.ajog.2019.11.1287] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/12/2019] [Accepted: 11/18/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess the efficacy, effectiveness, and safety of uterine balloon tamponade for treating postpartum hemorrhage. STUDY DESIGN We searched electronic databases (from their inception to August 2019) and bibliographies. We included randomized controlled trials, nonrandomized studies, and case series that reported on the efficacy, effectiveness, and/or safety of uterine balloon tamponade in women with postpartum hemorrhage. The primary outcome was the success rate of uterine balloon tamponade for treating postpartum hemorrhage (number of uterine balloon tamponade success cases/total number of women treated with uterine balloon tamponade). For meta-analyses, we calculated pooled success rate for all studies, and relative risk with 95% confidence intervals for studies that included a comparative arm. RESULTS Ninety-one studies, including 4729 women, met inclusion criteria (6 randomized trials, 1 cluster randomized trial, 15 nonrandomized studies, and 69 case series). The overall pooled uterine balloon tamponade success rate was 85.9% (95% confidence interval, 83.9-87.9%). The highest success rates corresponded to uterine atony (87.1%) and placenta previa (86.8%), and the lowest to placenta accreta spectrum (66.7%) and retained products of conception (76.8%). The uterine balloon tamponade success rate was lower in cesarean deliveries (81.7%) than in vaginal deliveries (87.0%). A meta-analysis of 2 randomized trials that compared uterine balloon tamponade vs no uterine balloon tamponade in postpartum hemorrhage due to uterine atony after vaginal delivery showed no significant differences between the study groups in the risk of surgical interventions or maternal death (relative risk, 0.59; 95% confidence interval, 0.02-16.69). A meta-analysis of 2 nonrandomized before-and-after studies showed that introduction of uterine balloon tamponade in protocols for managing severe postpartum hemorrhage significantly decreased the use of arterial embolization (relative risk, 0.29; 95% confidence interval, 0.14-0.63). A nonrandomized cluster study reported that use of invasive procedures was significantly lower in the perinatal network that routinely used uterine balloon tamponade than that which did not use uterine balloon tamponade (3.0/1000 vs 5.1/1000; P < .01). A cluster randomized trial reported that the frequency of postpartum hemorrhage-related invasive procedures and/or maternal death was significantly higher after uterine balloon tamponade introduction than before uterine balloon tamponade introduction (11.6/10,000 vs 6.7/10,000; P = .04). Overall, the frequency of complications attributed to uterine balloon tamponade use was low (≤6.5%). CONCLUSION Uterine balloon tamponade has a high success rate for treating severe postpartum hemorrhage and appears to be safe. The evidence on uterine balloon tamponade efficacy and effectiveness from randomized and nonrandomized studies is conflicting, with experimental studies suggesting no beneficial effect, in contrast with observational studies. Further research is needed to determine the most effective programmatic and healthcare delivery strategies on uterine balloon tamponade introduction and use.
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Affiliation(s)
- Sebastian Suarez
- Division of Global Health Innovation, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Internal Medicine, Boston Medical Center, Boston, Massachusetts.
| | - Agustin Conde-Agudelo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan
| | - Anderson Borovac-Pinheiro
- Division of Global Health Innovation, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas (SP), Brazil
| | - Daniela Suarez-Rebling
- Division of Global Health Innovation, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Melody Eckardt
- Division of Global Health Innovation, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Gerhard Theron
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Thomas F Burke
- Division of Global Health Innovation, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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9
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Mollazadeh-Moghaddam K, Dundek M, Bellare A, Borovac-Pinheiro A, Won A, Burke TF. Mechanical Properties of the Every Second Matters for Mothers-Uterine Balloon Tamponade (ESM-UBT) Device: In Vitro Tests. AJP Rep 2019; 9:e376-e383. [PMID: 31815053 PMCID: PMC6894953 DOI: 10.1055/s-0039-1697653] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/16/2019] [Indexed: 12/14/2022] Open
Abstract
Objective Postpartum hemorrhage (PPH) is the most common cause of maternal mortality and morbidity worldwide, most of which occurs in resource-poor settings. Placement of a uterine balloon may be life-saving in uncontrolled PPH. The Every Second Matters for Mothers-Uterine Balloon Tamponade (ESM-UBT) device is an ultra-low-cost uterine balloon designed for global access. The purpose of this study was to evaluate the mechanical properties of the ESM-UBT device. Study design Intraluminal pressures, diameters, and burst volumes of condom uterine balloons and Foley catheter balloons of ESM-UBT devices were measured in open air and inside uterus models. Condom uterine balloons were tested with uterus model sizes of 100, 250, and 500mL. The condom-catheter O-ring attachment tensile strength was also evaluated. Results All 28 samples of ESM-UBT condom uterine balloons maintained their integrity for at least 3 hours when subjected to pressures of 200 mm Hg or greater across each of the tested uterine volumes. No Foley catheter balloons burst after instillation of 30mL, O-rings withstood forces of 15.4 ± 2.1 N, and condom uterine balloons stretched to 35.8 ± 2.1 cm without loss of integrity. Conclusion The mechanical properties of the ESM-UBT device make it attractive for scale across resource-poor settings.
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Affiliation(s)
- Kamyar Mollazadeh-Moghaddam
- Division of Global Health Innovation, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Michelle Dundek
- Division of Global Health Innovation, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Anuj Bellare
- Division of Global Health Innovation, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Anderson Borovac-Pinheiro
- Division of Global Health Innovation, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Alice Won
- Division of Global Health Innovation, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Thomas F Burke
- Division of Global Health Innovation, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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