1
|
Hofmeyr GJ. Novel concepts and improvisation for treating postpartum haemorrhage: a narrative review of emerging techniques. Reprod Health 2023; 20:116. [PMID: 37568196 PMCID: PMC10422815 DOI: 10.1186/s12978-023-01657-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- G J Hofmeyr
- Department of Obstetrics and Gynaecology, University of Botswana, Notwane Rd, Gaborone, Botswana.
- Universities of the Witwatersrand and Walter Sisulu, East London, South Africa.
| |
Collapse
|
2
|
Parker ME, Qureshi Z, Deganus S, Soki J, Cofie P, Dapaah P, Owusu R, Gwako G, Osoti A, Ogutu O, Opira J, Sunkwa-Mills G, Boamah M, Srofenyoh E, Aboagye P, Fofie C, Kaliti S, Morozoff C, Secor A, Metzler M, Abu-Haydar E. Introduction of the Ellavi uterine balloon tamponade into the Kenyan and Ghanaian maternal healthcare package for improved postpartum haemorrhage management: an implementation research study. BMJ Open 2023; 13:e066907. [PMID: 36737079 PMCID: PMC9900048 DOI: 10.1136/bmjopen-2022-066907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Use 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. DESIGN A 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. SETTING Three Ghanaian (district, regional) and three Kenyan (levels 4-6) healthcare facilities. PARTICIPANTS Obstetric staff (n=451) working within participating facilities. INTERVENTION PPH management training courses were conducted with obstetric staff. PRIMARY AND SECONDARY OUTCOME MEASURES Facility measures of adoption, sustainability and fidelity and individual measures of acceptability and feasibility. RESULTS All 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. CONCLUSIONS The 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 NUMBERS NCT04502173; NCT05340777.
Collapse
Affiliation(s)
| | - Zahida Qureshi
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - Sylvia Deganus
- Department of Obstetrics and Gynecology, Tema General Hospital, Tema, Ghana
| | | | | | | | | | - George Gwako
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - Alfred Osoti
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - Omondi Ogutu
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - Jacqueline Opira
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - Gifty Sunkwa-Mills
- Awutu Senya East Municipal, Ghana Health Service, Kasoa, Central Region, Ghana
| | - Martin Boamah
- Department of Obstetrics and Gynaecology, Greater Accra Regional Hospital, Accra, Greater Accra, Ghana
| | - Emmanuel Srofenyoh
- Department of Obstetrics and Gynaecology, Greater Accra Regional Hospital, Accra, Greater Accra, Ghana
| | | | - Chris Fofie
- Ghana Health Service, Accra, Greater Accra, Ghana
| | - Stephen Kaliti
- Division of Reproductive and Maternal Health, Kenya Ministry of Health, Nairobi, Kenya
| | - Chloe Morozoff
- Global Health, University of Washington, Seattle, Washington, USA
| | | | - Mutsumi Metzler
- Medical Devices and Health Technologies, PATH, Seattle, Washington, USA
| | | |
Collapse
|