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Water-filled balloon used to stop post-birth bleeding and save lives

Friday December 09 2016

Last year, Regina Adhiambo was rushed to Othoro Level 4 Hospital, a health facility in Homa Bay County, in labour. A team of healthcare workers received her and successfully delivered a baby girl.

But they encountered a problem. They could not stop the mother’s bleeding.

Adhiambo was suffering from post-partum haemorrhage, now a leading cause of maternal deaths in East Africa.

Mothers with this complication usually undergo urgent surgery and blood transfusion to save their lives.

However, healthcare workers with the skills and appropriate medical equipment to perform such surgeries are rare in rural health facilities, where the majority of East African women deliver.

Luckily for her, Othoro Level 4 Hospital is among a number of rural hospitals in East Africa that have a uterine balloon tamponade (UBT) — a device developed by PATH that has been proven to reduce or stop excessive bleeding after delivery in 15 minutes or less.

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The UBT was developed in the early 2000s and costs less than $5. The promotion of the technology in East Africa began in 2014 and is still ongoing. Health workers in target institutions are being trained in its use.

Unlike surgeries that can only be performed by doctors in major facilities, UBT can be used by the low cadre health workers such as clinical officers and nurses who usually serve rural health facilities in the region.

It is for this reason that the World Health Organisation has now included UBT in its guidelines for the management of post-partum haemorrhage, especially in low income settings.

Balloon-like apparatus

To promote its use, PATH and other non-governmental organisations have been working with Health Ministries across the region to train health workers in the technology and to promote its use in rural hospitals.

The UBT comprises a balloon-like apparatus that is inserted in a woman’s uterus. The apparatus is then slowly filled with water through a syringe.

As this happens, it becomes inflated or begins expanding while applying pressure on blood vessels lining the uterus wall. It is this pressure that reduces the bleeding.

“The health workers will then keep observing the patient and once certain that the bleeding has stopped, they begin draining the water slowly by releasing about 100ml every 30 minutes,” said Elizabeth Odhiambo, an expert on the UBT technology from PATH.

In instances where the bleeding fails to stop, the apparatus is still useful as it gives hospital staff time to prepare the affected patient and arrange to transfer her to higher level hospitals with the human resource and equipment to perform required surgeries.

“As long as the water-filled balloon is still inside the uterus, then you have a safe period of about 6 hours when the patient will still be okay. This gives you time to plan a referral,” said Edwin Koko, a nurse at Othoro Level 4 Hospital who has used the UBT.

Poor roads and lack of ambulances often cause delays in transferring patients to referral hospitals.

Compressing the uterus

“Due to these challenges, women with post-partum haemorrhage would sometimes just die on the way. But with the UBT, they are now reaching referral hospitals when they are still in good condition,” said Samwel Koech, a clinical officer in charge of Othoro Hospital.

He adds that previously, health workers would attempt to control the bleeding by manually compressing the uterus as a mother is being transferred to another hospital.

“This used to cause a lot of discomfort to patients and could lead to injury of adjacent organs,” added Dr Koech.

The technology is also helping higher level public hospitals in East Africa to tackle congestion challenges.

When theatres are fully occupied, the UBT helps to control bleeding among patients waiting for doctors to attend to them.

The UBT is also gaining popularity in the region as it can easily be made using low-cost and readily available supplies found in all health facilities. With just a condom (to act as the balloon), syringe and rubber tubing, health workers will have a ready UBT kit to prevent heavy bleeding in mothers.

Post-partum haemorrhage is often defined as the loss of more than 500 ml of blood within the first 24 hours following child birth.

Affected women tend to have increased heart rates. They appear weak and may feel like fainting upon standing.

This excessive bleeding eventually causes a severe drop in blood pressure and may lead to shock and death if it is not treated quickly.

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The condition is caused by poor contraction or tears of the uterus after childbirth.

Clotting disorders

Heavy bleeding can also occur if the placenta is not completely removed from the uterus after delivery. Women who are obese and those with hypertension or blood clotting disorders have a higher risk of postpartum haemorrhage.

Multiple births tend to loosen uterus walls and could cause postpartum. The damage can be reduced through adequate spacing of births at at least two year intervals.

After delivery, mothers are often given a drug known as oxytocin to stimulate rapid contraction of the uterus. Breastfeeding immediately after birth is also encouraged for the same purpose.

But sometimes these two approaches fail, forcing health workers to use other alternatives like UBT.

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