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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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Kalsvik S, Lukasse M, Myhre EL. Midwives' experiences with aortic compression for postpartum hemorrhage: A qualitative study. Eur J Midwifery 2023; 7:35. [PMID: 38023946 PMCID: PMC10665914 DOI: 10.18332/ejm/172880] [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: 09/12/2023] [Revised: 09/22/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION The aim of this study was to examine midwives' firsthand experience with aortic compression during postpartum hemorrhage. Severe postpartum hemorrhage is a critical complication during childbirth and the leading cause of maternal morbidity and mortality. Active management of the third stage of labor, combined with standard treatment, has reduced the incidence. However, these measures occasionally fall short, and there is a global need for easy, effective alternative methods. Aortic compression, though not widely recognized, is employed intermittently and lacks substantial scientific backing. METHODS This qualitative study comprised interviews with midwives from various healthcare settings across Norway. Over a two-month period in 2022, we conducted seven individual semi-structured interviews. Interview transcripts were thematically analyzed using Braun and Clarke's six-step process. RESULTS Four prominent themes emerged from the analysis, reflecting midwives' experiences with aortic compression in managing postpartum hemorrhage (PPH). In their experiences with aortic compression, midwives uncovered its dual qualities of being both easy and effective. Their utilization of the technique was experience-based only, shaped by personal experience rather than formal training. Nevertheless, aortic compression was perceived as the first-line response to suspected postpartum hemorrhage, preventing escalation, and offering a clearer view of the situation to facilitate timely treatment. Most significantly, midwives recognized aortic compression as a crucial intervention that reduces blood loss and improves health. CONCLUSIONS Postpartum hemorrhage is a feared situation in the delivery room. The participants consider that aortic compression may affect maternal health and mortality. However, further research is necessary.
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Affiliation(s)
- Sonja Kalsvik
- Centre for Women’s, Family and Child Health, Faculty of Health Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Mirjam Lukasse
- Centre for Women’s, Family and Child Health, Faculty of Health Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Enid L. Myhre
- Centre for Women’s, Family and Child Health, Faculty of Health Sciences, University of South-Eastern Norway, Kongsberg, Norway
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Gutiérrez-Peláez K, Aranda Z, Jiménez-Peña A, Mata-González H. How inequity threatens the lives of pregnant women: barriers to accessing health services during an incomplete miscarriage in rural southern Mexico. BMJ Case Rep 2022; 15:15/5/e248819. [PMID: 35606027 PMCID: PMC9174763 DOI: 10.1136/bcr-2022-248819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Globally, obstetric emergencies majorly account for maternal morbidity and mortality. Guerrero, Oaxaca and Chiapas accounted for more than 13% of maternal deaths in the country in 2021. Obstetric haemorrhage was the leading cause of maternal death after COVID-19 infection and hypertensive disorders. This case highlights the clinical course and social determinants of health that limited access to health services in a young woman with an obstetric emergency in rural southern Mexico. The case describes common challenges during an obstetric emergency in resource-poor settings, such as timely referral to a second level of care. Our analysis identifies the social determinants of health behind the slow and inadequate emergency response. Additionally, we present several interventions that can be implemented in low-resource settings for strengthening the response to obstetric emergencies at the primary and secondary levels of care.
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Affiliation(s)
- Karen Gutiérrez-Peláez
- Programa de Médico Cirujano, Escuela de Medicina y Ciencias de la Salud del Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Nuevo León, México
| | - Zeus Aranda
- Programa de Investigación e Impacto, Partners In Health México/Compañeros En Salud, Ángel Albino Corzo, Chiapas, México
- Departamento de Salud, El Colegio de la Frontera Sur, San Cristóbal de las Casas, Chiapas, México
| | - Andrea Jiménez-Peña
- Programa Multicéntrico de Especialidades Médicas, Escuela de Medicina y Ciencias de la Salud del Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Nuevo León, México
| | - Hellen Mata-González
- Programa de Salud Sexual y Reproductiva, Partners In Health México/Compañeros En Salud, Ángel Albino Corzo, Chiapas, México
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Cebekhulu SN, Abdul H, Batting J, Chauke L, Dlakavu F, Fawcus S, Govender L, Majeke B, Mbongozi X, Singata-Madliki M, Middleton K, Mlandu P, Naidoo P, Ndaba S, Soma-Pillay P, Spence T, Ntambua SC, Hofmeyr J. "Suction Tube Uterine Tamponade" for treatment of refractory postpartum hemorrhage: Internal feasibility and acceptability pilot of a randomized clinical trial. Int J Gynaecol Obstet 2021; 158:79-85. [PMID: 34605016 DOI: 10.1002/ijgo.13963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/09/2021] [Accepted: 09/30/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess feasibility and acceptability of a novel, low-cost "Suction Tube Uterine Tamponade" (STUT) treatment for refractory postpartum hemorrhage (PPH). METHODS We allocated patients with refractory PPH by randomly ordered envelopes to STUT or routine uterine balloon tamponade (UBT, Ellavi free-flow system) in 10 hospitals in South Africa. In the STUT group, a 24FG Levin stomach tube was inserted into the uterine cavity and vacuum created with a vacuum pump or manual vacuum aspiration syringe. RESULTS For this internal pilot study, 12 participants were allocated to STUT and 12 to UBT. Insertion failed in one of each group and was recorded as difficult in 3/10 STUT and 4/9 UBT insertions respectively (five missing data). There were two laparotomies and one intensive care unit admission in the UBT group. Pain during STUT insertion was graded as none/mild in 9/10 and severe in 1/10. The experience of the STUT procedure was graded as fine in 4/11 and "uncomfortable but acceptable" in 7/11. CONCLUSION STUT is feasible and acceptable, justifying continuation of our trial. These data will also inform a large World Health Organization trial to test effectiveness of uterine tamponade methods. The numbers are too small to support any clinical recommendation.
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Affiliation(s)
- Sylvia N Cebekhulu
- Department of Obstetrics and Gynaecology, Department of Health, Bloemfontein, Bongani Regional Hospital, University of the Free State, Hartbeespoort, South Africa
| | - Hazmath Abdul
- Department of Obstetrics & Gynaecology, Queen Nandi Regional Hospital, Empangeni, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Joanne Batting
- Effective Care Research Unit, Eastern Cape Department of Health, Universities of the Witwatersrand, Walter Sisulu, and Fort Hare, East London, South Africa
| | - Lawrence Chauke
- Department Obstetrics and Gynaecology Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Witwatersrand, South Africa
| | - Fuziwe Dlakavu
- Department of Obstetrics and Gynaecology, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Sue Fawcus
- Department Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa
| | - Logie Govender
- Department of Obstetrics & Gynaecology, Queen Nandi Regional Hospital, Empangeni, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Busiwe Majeke
- Department of Obstetrics and Gynaecology at Cecilia Makiwane Hospital, Walter Sisulu University, East London, South Africa
| | - Xolani Mbongozi
- Department of Obstetrics and Gynaecology, Nelson Mandela Academic Hospital, Walter Sisulu University, Mthatha, South Africa
| | - Mandisa Singata-Madliki
- Effective Care Research Unit, Eastern Cape Department of Health, Universities of the Witwatersrand, Walter Sisulu, and Fort Hare, East London, South Africa
| | - Katrin Middleton
- Department of Obstetrics and Gynaecology, Frere Hospital and Walter Sisulu University, East London, South Africa
| | - Philiswa Mlandu
- Department of Obstetrics and Gynaecology, Chris Hani Baragwaneth Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Poovangela Naidoo
- Department of Obstetrics and Gynaecology, Chris Hani Baragwaneth Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Sanele Ndaba
- Department of Obstetrics and Gynaecology Kalafong Hospital, University of Pretoria, Pretoria, South Africa
| | - Priya Soma-Pillay
- UP/SAMRC Research Centre for Maternal, Fetal, Newborn and Child Healthcare Strategies, Department of Obstetrics and Gynaecology Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Trevi Spence
- Department of Obstetrics and Gynaecology, New Somerset Hospital, Cape Town, South Africa
| | - Symphorien C Ntambua
- Department of Health, Department of Obstetrics and Gynaecology, Bongani Regional Hospital, Free State, Hartbeespoort, South Africa
| | - Justus Hofmeyr
- Effective Care Research Unit, Eastern Cape Department of Health, Universities of the Witwatersrand, Walter Sisulu, and Fort Hare, East London, South Africa.,University of Botswana, Botswana, South Africa
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