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Obstetric hemorrhage in resource‐limited locations: A quality improvement project after adoption of abdominopelvic compression devices
Author(s) -
Kerr Nancy L.,
Hauswald Mark,
Tamrakar Suman R.,
Kalit Solomon
Publication year - 2020
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.13291
Subject(s) - medicine , uterine atony , referral , hysterectomy , surgery , obstetrics , medical emergency , nursing
Abstract Objective To evaluate obstetric hemorrhage outcomes and present data specific to adoption of pneumatic circumferential abdominopelvic compression devices. Methods Two resource‐limited locations added low‐cost pneumatic compression devices to their standard protocols for obstetric hemorrhage between 2010 and 2019. Providers in rural Nepal and Papua New Guinea used devices that incorporated a bicycle tube or soccer ball (“Ball and Binder”) to provide abdominopelvic pressure after all available routine treatments had failed. Data were collected during the entire period as part of ongoing obstetric quality improvement. Data presented include obstetric event, etiology of bleeding, need for surgery, transfusion, transport, length of transports, maternal survival, and complications. Results Circumferential abdominopelvic compression was used 106 times. The devices were used primarily after vaginal birth with atony, but also for obstetrical lacerations, miscarriages, and post‐abortion bleeding. In all cases the bleeding stopped “promptly.” All women survived, none required hysterectomy, and no complications were reported resulting from device use. Only 15 (14%) patients were transported to a referral hospital. Conclusion In this quality improvement project, obstetric hemorrhage was controlled when circumferential pressure was applied after usual care had failed.