A Qualitative Assessment of the Impact of a Uterine Balloon Tamponade Package on Decisions Regarding the Role of Emergency Hysterectomy in Women With Uncontrolled Postpartum Hemorrhage in Kenya and Senegal

Abstract

Purpose: To assess the impact of a every second matters for mothers and babies uterine balloon tamponade package (ESM-UBT) on provider decisions regarding emergency hysterectomy in cases of uncontrolled postpartum hemorrhage (PPH). Methods: This study was performed as a qualitative assessment of a subgroup extracted from a database containing all UBT device uses among ESM-UBT trained health providers. The database was analyzed for all medical doctors in Kenya and Senegal who had placed a UBT for uncontrolled PPH subsequent to implementation of ESM-UBT at their facility, and who also had the capabilities of performing emergency hysterectomies. Semi-structured interviews were conducted with providers using a standardized guide. Interview transcripts were analyzed independently by two researchers. Results: 30 of the 31 medical doctors (97%) who fulfilled the inclusion criteria were independently interviewed. Collectively the interviewed medical doctors had placed over 80 UBT devices for uncontrolled PPH since ESM-UBT implementation. All 30 responded that UBT devices immediately controlled hemorrhage and prevented women from being taken to emergency hysterectomy. All 30 would continue to use UBT devices in future cases of uncontrolled PPH. Conclusions: These preliminary data suggest that following ESM-UBT implementation, emergency hysterectomy for uncontrolled PPH may be averted by use of uterine balloon tamponade.