Uterine balloon tamponade for the treatment of postpartum haemorrhage in resource-poor settings: a systematic review

ObjectivePostpartum 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.DesignHealth system cost was estimated using primary economic microcosting, data from Health Management Information System and published literature for event probabilities.SettingsFour public health facilities from the state of Maharashtra, India representing primary, secondary and tertiary level care were chosen for primary costing.Outcome measuresUnit, 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.ResultsMedical 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).ConclusionsAtonic 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.

Download Full-text

Uterine balloon tamponade for the treatment of postpartum hemorrhage: a systematic review and meta-analysis—commentary

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2020.01.018 ◽

2020 ◽

Vol 222 (4) ◽

pp. 291-292 ◽

Cited By ~ 1

Author(s):

Sabaratnam Arulkumaran ◽

Carlos Fuchtner

Keyword(s):

Systematic Review ◽

Postpartum Hemorrhage ◽

Meta Analysis ◽

Balloon Tamponade ◽

Uterine Balloon Tamponade

Download Full-text

Factors Associated with Failure of Bakri Balloon Tamponade for the Management of Postpartum Haemorrhage. Case Series Study and Systematic Review

Healthcare ◽

10.3390/healthcare9030295 ◽

2021 ◽

Vol 9 (3) ◽

pp. 295

Author(s):

Francisco Ruiz Labarta ◽

María Pintado Recarte ◽

Laura Joigneau Prieto ◽

Coral Bravo Arribas ◽

Julia Bujan ◽

...

Keyword(s):

Systematic Review ◽

Caesarean Delivery ◽

Postpartum Haemorrhage ◽

Case Series ◽

Cochrane Library ◽

Balloon Tamponade ◽

Estimated Blood Loss ◽

Case Series Study ◽

Series Study ◽

Bakri Balloon

Background: Postpartum haemorrhage (PPH) is an unpredictable obstetric emergency that requires a multidisciplinary approach. Bakri balloon tamponade (BBT) is recommended when PPH does not respond to medical treatment. Nowadays few published studies have performed a multivariate analysis to determine the variables independently associated with BBT failure. Methods: Our study purpose was to determine the variables independently associated with BBT failure: first, in a large single-centre cohort study between 2010 and 2020, and second, in a systematic literature review using Medline and the Cochrane Library. Maternal and perinatal variables, PPH characteristics, technique-related variables and complications were recorded in the case series study, comparing between successful and failed BBT patients. Study characteristic and variables significantly associated with BBT failure were recorded in the systematic review. All studies used a logistic regression test. Results: The case series included 123 patients. The profile of these patients were primiparous, with vaginal delivery and a full-term new-born. BBT was successful in 81.3% of cases. Five studies were included in the systematic review, providing data from 551 patients. BBT was successful in 79.5% of cases. Conclusions: Maternal age, caesarean delivery, ≥7 red blood cells units (RBCU) transfused and curettage before BBT insertion, history of caesarean section, pre-pregnancy obesity, anteriorly placed placenta, placenta accreta, caesarean delivery, estimated blood loss before insertion of BBT, long operation duration, and coagulopathy were independent factors for BBT failure.

Download Full-text

Uterine Balloon Tamponade for the Treatment of Postpartum Hemorrhage: A Systematic Review and Meta-analysis

Obstetric Anesthesia Digest ◽

10.1097/01.aoa.0000732356.23836.42 ◽

2021 ◽

Vol 41 (1) ◽

pp. 8-9

Author(s):

S. Suarez ◽

A. Conde-Agudelo ◽

A. Borovac-Pinheiro ◽

D. Suarez-Rebling ◽

M. Eckardt ◽

...

Keyword(s):

Systematic Review ◽

Postpartum Hemorrhage ◽

Meta Analysis ◽

Balloon Tamponade ◽

Uterine Balloon Tamponade

Download Full-text

Uterine balloon tamponade as an adjunct to misoprostol for the treatment of uncontrolled postpartum haemorrhage: a randomised controlled trial in Benin and Mali

BMJ Open ◽

10.1136/bmjopen-2017-016590 ◽

2017 ◽

Vol 7 (9) ◽

pp. e016590 ◽

Cited By ~ 13

Author(s):

Alexandre Dumont ◽

Cécile Bodin ◽

Benjamin Hounkpatin ◽

Thomas Popowski ◽

Mamadou Traoré ◽

...

Keyword(s):

Relative Risk ◽

Randomised Controlled Trial ◽

Postpartum Haemorrhage ◽

Controlled Trial ◽

Case Fatality ◽

Control Group ◽

Total Blood ◽

Balloon Tamponade ◽

Uterine Balloon Tamponade ◽

Randomised Controlled

ObjectiveTo assess the effectiveness of low-cost uterine tamponade as an adjunct to misoprostol for the treatment of uncontrolled postpartum haemorrhage (PPH) in low-resource settings.DesignRandomised controlled trial.SettingSeven healthcare facilities in Cotonou, Benin and Bamako, Mali.PopulationWomen delivering vaginally who had clinically diagnosed PPH that was suspected to be due to uterine atony, who were unresponsive to oxytocin and who needed additional uterotonics.MethodsWomen were randomly assigned to receive uterine balloon tamponade with a condom-catheter device or no tamponade; both groups were also given intrarectal or sublingual misoprostol.Main outcome measureProportion of women with invasive surgery or who died before hospital discharge.ResultsThe proportion of primary composite outcome did not differ significantly between the tamponade arm (16%; 9/57) and the standard second line treatment arm (7%; 4/59): relative risk 2.33 (95% CI 0.76 to 7.14, p=0.238). A significantly increased proportion of women with tamponade and misoprostol versus misoprostol alone had total blood loss more than 1000 mL: relative risk 1.52 (95% CI 1.15 to 2.00, p=0.01). Case fatality rate was higher in the tamponade group (10%; 6/57) than in the control group (2%; 1/59) (p=0.059).Trial registration numberISRCT Registry Number 01202389; Post-results.

Download Full-text

Mechanical Properties of the Every Second Matters for Mothers-Uterine Balloon Tamponade (ESM-UBT) Device: In Vitro Tests

American Journal of Perinatology Reports ◽

10.1055/s-0039-1697653 ◽

2019 ◽

Vol 09 (04) ◽

pp. e376-e383 ◽

Cited By ~ 1

Author(s):

Kamyar Mollazadeh-Moghaddam ◽

Michelle Dundek ◽

Anuj Bellare ◽

Anderson Borovac-Pinheiro ◽

Alice Won ◽

...

Keyword(s):

Mechanical Properties ◽

Low Cost ◽

Foley Catheter ◽

In Vitro Tests ◽

Mortality And Morbidity ◽

Balloon Tamponade ◽

Life Saving ◽

Resource Poor ◽

Uterine Balloon Tamponade

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.

Download Full-text