A Multi - Disciplinary Research Collaboration.

UBT

Introduction of a Uterine Balloon Tamponade for Postpartum Hemorrhage in Three Low Income Countries.

Postpartum hemorrhage (PPH) is one of the main contributors to maternal morbidity and mortality globally. Though administration of a uterotonic effectively controls bleeding for most women who have PPH, about 5-10% of diagnosed PPH cases will require additional interventions beyond uterotonics to stop bleeding.  In many low resource settings, these second- and third-line therapies, including blood transfusion and surgical procedures, are not immediately available or feasible outside of tertiary care centers. Additional low-tech definitive treatments are urgently needed to fill the gap in care.

Use of the Uterine Balloon Tamponade (UBT) is recognized by several agencies, including World Health Organization (WHO), International Federation of Gynecologist & Obstetricians (FIGO), and International Confederation of Midwives (ICM), as an effective means of limiting blood loss in refractory PPH. The UBT is a medical technique that uses a balloon to apply pressure to the inside of the uterus to stop bleeding after delivery. It is used when primary interventions fail. The UBT used in this study consists of a urinary catheter, a condom, cotton string ties, a large syringe, and a one-way valve. The condom attached to the catheter is inserted into the uterus and inflated with water. The balloon can stay in place for up to 24 hours.

The project will investigate the following questions:

  • Does introduction of the UBT as a treatment option for PPH at secondary level and district referral facilities result in improved maternal health outcomes (i.e., reduced PPH-related mortality, fewer women who receive invasive postpartum surgical procedures and fewer women who receive postpartum blood transfusion)when compared to facilities that have not yet introduced UBT for PPH management?
  • Does introduction of the UBT result in an increased incidence of postpartum infection in women with a PPH?
  • Is UBT feasible to use at secondary level and district referral hospitals?
  • What is the level of pain associated with having a UBT placed, particularly when anesthesia is not administered?
  • What is the overall acceptability of UBT use from the perspective of women and providers?
  • What are the factors that influence the provision of effective PPH care within specific country settings?

This research is taking place in Egypt, Senegal and Uganda and will include 18 secondary level and district referral hospitals with an average of 160 vaginal deliveries a month. In Uganda, it will take place in 6 district hospitals namely; Gombe Hospital, Masindi Hospital, Kiryandongo Hospital, Itojo Hospital, Lyantonde Hospital and Kitagata Hospital. It will run over a period of 15 months from November 2016 to March 2018.

This research is a joint collaboration of Gynuity Health Projects, Massachusetts General Hospital and local partners in each country which in Uganda are Makerere University and Global Health Uganda.

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