scholarly journals A case series of post-partum haemorrhage managed using Ellavi uterine balloon tamponade in a rural regional hospital

2021 ◽  
Vol 63 (1) ◽  
Author(s):  
Gerhard B. Theron ◽  
Vulikaya Mpumlwana
Keyword(s):  
Post Partum ◽  
Case Series ◽  
Regional Hospital ◽  
Referral Hospital ◽  
Eastern Cape ◽  
Tertiary Referral Hospital ◽  
Balloon Tamponade ◽  
Nelson Mandela ◽  
Uterine Balloon Tamponade ◽  
Post Partum Haemorrhage

Uterine balloon tamponade (UBT) should be attempted once emergency measures have been applied and medical treatment for post-partum haemorrhage (PPH) resulting from an atonic uterus has failed. Sinapi Biomedical (Pty) Ltd developed the Ellavi UBT, a free-flow pressure-controlled UBT unit. The device is affordable for use in lesser-resourced countries. A case series of Ellavi UBT used by medical officers in a rural regional hospital without specialist supervision was conducted. This case series was conducted in St Elizabeth’s Hospital in Lusikisiki, South Africa. The hospital serves as the regional hospital for the Ingquza Hill Subdistrict in the Eastern Cape Province. The Nelson Mandela Academic Hospital (NMAH) in Mthatha is the tertiary referral hospital. Workshops were conducted on the use of Ellavi UBT, and devices were made freely available to the hospital. The case series included 10 patients. Six patients delivered by caesarean section, and four had normal vertex deliveries. All patients had additional oxytocin infusions, and eight patients received misoprostol. Following the insertion and inflation of the Ellavi UBT, the PPH stopped in seven patients, was much reduced in one patient and reduced in one patient. In one case, the Ellavi UBT had no effect on the bleeding. All 10 patients were referred to the NMAH. All patients in the case series had good outcomes. The insertion of the Ellavi UBT and subsequent referral proved to be feasible in a rural regional hospital. All patients included in the case series arrived at the referral hospital and had a good outcome.

Solution to Technical Difficulties of Uterine Balloon Tamponade Placement in Primary PPH Management: A Retrospective Case Series

2021 ◽  
Vol 15 (9) ◽  
pp. 2467-2469
Author(s):  
Noreen Nasim ◽  
Shazia Majid Khan ◽  
Ayesha Zafar ◽  
Sara Yousuf ◽  
Moeen Akhtar Malik
Keyword(s):  
Post Partum ◽  
Case Series ◽  
Hospital Data ◽  
Retrospective Case ◽  
Surgical Interventions ◽  
Balloon Tamponade ◽  
Retrospective Case Series ◽  
Gynecology And Obstetrics ◽  
Case Series Study ◽  
Uterine Balloon Tamponade

Objective: The aim of this study was to devise and enforce a simple yet effective method of condom placement for IUBT while dealing with all the technical difficulties in a poor resource setup to control primary PPH to save life of mother. Methodology: It is a retrospective case series study that is based on the hospital data obtained from Gynecology and Obstetrics Department of Sheikh Zayed Hospital, Rahim Yar Khan for a period of 8 months (July 2019 to Feb 2020) . Patients with persistent primary PPH after medical management who were given intra-uterine balloon tamponade (IUBT) were included in this study after evaluation for possible risk factors of PPH. Sample size was kept 30 with power of test at 80% and level of significance at 5%. Statistical assessment of the variables was done and the data was analyzed with SPSS v.21. Results: The 30 female patients, included in this study, had mean age of 30.3±6.06 years ranging from 17 to 39 years. Condom IUBT was successfully placed in 28(93.3%) patients by using 4 ring forceps applied on cervix and tied together with a gauze to keep the balloon in utero in order to control bleeding of PPH while in 2(6.66%) patients; it was unsuccessful due to inexperience of the operating staff. Out of these 28 patients with successful IUBT placement, condom based intra-uterine balloon tamponade was successful in controlling bleeding of PPH in 26(92.86%) patients while in 2(7.14%) patients, bleeding was not controlled and they underwent surgical interventions. Conclusion: Condom based Intra-uterine balloon tamponade is a simple yet effective method to control bleeding in primary postpartum hemorrhage but needs positive re-enforcement in the form of awareness/training sessions for the healthcare staff. Keywords: Catheter, Post-Partum Morbidity, Condom, Intra-Uterine Balloon Tamponade, Hemorrhage, Hysterectomy

scholarly journals Kaposi’s sarcoma in persons living with HIV/AIDS: a case series in a tertiary referral hospital

2018 ◽  
Vol 93 (4) ◽  
pp. 524-528
Author(s):  
Carla Andréa Avelar Pires ◽  
Marcos Antonio Neves Noronha ◽  
Julius Caesar Mendes Soares Monteiro ◽  
Albert Luiz Costa da Costa ◽  
José Maria de Castro Abreu Júnior
Keyword(s):  
Kaposi's Sarcoma ◽  
Case Series ◽  
Kaposi’S Sarcoma ◽  
Referral Hospital ◽  
Tertiary Referral ◽  
Tertiary Referral Hospital ◽  
Persons Living With Hiv ◽  
Living With Hiv ◽  
Hiv Aids

scholarly journals Cost-effectiveness of uterine balloon tamponade devices in managing atonic post-partum hemorrhage at public health facilities in India

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256271
Author(s):  
Beena Nitin Joshi ◽  
Siddesh Sitaram Shetty ◽  
Kusum Venkobrao Moray ◽  
Oshima Sachin ◽  
Himanshu Chaurasia
Keyword(s):  
Public Health ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Cost Saving ◽  
Incremental Cost ◽  
Post Partum ◽  
Public Health Facilities ◽  
Post Partum Hemorrhage ◽  
Balloon Tamponade ◽  
Uterine Balloon Tamponade

Objective Post-partum hemorrhage (PPH) is the leading direct cause of maternal mortality in India. Uterine balloon tamponade (UBT) is recommended for atonic PPH cases not responding to uterotonics. This study assessed cost-effectiveness of three UBT devices used in Indian public health settings. Methods A decision tree model was built to assess cost-effectiveness of Bakri-UBT and low-cost ESM-UBT alternatives as compared to the recommended standard of care i.e. condom-UBT intervention. A hypothetical annual cohort of women eligible for UBT intervention after experiencing atonic PPH in Indian public health facilities were evaluated for associated costs and outcomes over life-time horizon using a disaggregated societal perspective. Costs by undertaking primary costing and clinical parameters from published literature were used. Incremental cost per Disability Adjusted Life Years (DALY) averted, number of surgeries and maternal deaths with the interventions were estimated. An India specific willingness to pay threshold of INR 24,211 (USD 375) was used to evaluate cost-effectiveness. Detailed sensitivity analysis and expected value of information analysis was undertaken. Results ESM-UBT at base-case Incremental Cost-Effectiveness Ratio (ICER) of INR -2,412 (USD 37) per DALY averted is a cost-saving intervention i.e. is less expensive and more effective as compared to condom-UBT. Probabilistic sensitivity analysis however shows an error probability of 0.36, indicating a degree of uncertainty around model results. Bakri-UBT at an ICER value of INR -126,219 (USD -1,957) per DALY averted incurs higher incremental societal costs and is less effective as compared to condom-UBT. Hence, Bakri-UBT is not cost-effective. Conclusion For atonic PPH management in India, condom-UBT offers better value as compared to Bakri-UBT. Given the limited clinical effectiveness evidence and uncertainty in sensitivity analysis, cost-saving result for ESM-UBT must be considered with caution. Future research may focus on generating high quality comparative clinical evidence for UBT devices to facilitate policy decision making.

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