16 research outputs found
Time for global scale-up, not randomized trials, of uterine balloon tamponade for postpartum hemorrhage.
Maternal death is the greatest health disparity globally, with postpartum hemorrhage the most common cause. As senior leaders in obstetrics and maternal health from Bolivia, Canada, Colombia, CĂŽte d'Ivoire, Honduras, India, Kenya, Nepal, Niger, Norway, Peru, Tanzania, the UK, the USA, and Zambia, we are deeply disturbed by recent calls for randomized controlled trials (RCTs) of uterine balloon tamponade (UBT) in women with uncontrolled postpartum hemorrhage (PPH). Our collective experience, in combination with mounting evidence, unequivocally supports the effectiveness of commercial and condom UBTs in averting death and disability from PPH associated with atonic uterus. We believe it would be highly unethical to embark on an RCT of UBT, now or in the future, unless compared with a proven equivalent intervention. This article is protected by copyright. All rights reserved
Manipulating the expression of chemokine receptors enhances delivery and activity of cytokine-induced killer cells
Hysterectomy for gynaecological cancer: A follow-up study of subjective and objective outcome
Good clinical practice advice : prediction of preterm labor and preterm premature rupture of membranes
Postpartum hemorrhage care bundles to improve adherence to guidelines: A WHO technical consultation
Objective
To systematically develop evidenceâbased bundles for care of postpartum hemorrhage (PPH).
Methods
An international technical consultation was conducted in 2017 to develop draft bundles of clinical interventions for PPH taken from the WHO's 2012 and 2017 PPH recommendations and based on the validated âGRADE EvidenceâtoâDecisionâ framework. Twentyâthree global maternalâhealth experts participated in the development process, which was informed by a systematic literature search on bundle definitions, designs, and implementation experiences. Over a 6âmonth period, the expert panel met online and via teleconferences, culminating in a 2âday inâperson meeting.
Results
The consultation led to the definition of two care bundles for facility implementation. The âfirst response to PPH bundleâ comprises uterotonics, isotonic crystalloids, tranexamic acid, and uterine massage. The âresponse to refractory PPH bundleâ comprises compressive measures (aortic or bimanual uterine compression), the nonâpneumatic antishock garment, and intrauterine balloon tamponade (IBT). Advocacy, training, teamwork, communication, and use of best clinical practices were defined as PPH bundle supporting elements.
Conclusion
For the first response bundle, further research should assess its feasibility, acceptability, and effectiveness; and identify optimal implementation strategies. For the response to refractory bundle, further research should address pending controversies, including the operational definition of refractory PPH and effectiveness of IBT devices