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Provider experiences with uterine balloon tamponade for uncontrolled postpartum hemorrhage in health facilities in Kenya
Author(s) -
Natarajan Abirami,
Chavez Jean,
Ahn Roy,
Nelson Brett D.,
Eckardt Melody,
Dulo Liddy,
Achieng Emmaculate,
Oguttu Monica,
Tester Kristina,
Burke Thomas F.
Publication year - 2015
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 - 10.1016/j.ijgo.2015.05.020
Subject(s) - medicine , hysterectomy , thematic analysis , qualitative research , balloon tamponade , referral , health facility , medical emergency , obstetrics , family medicine , nursing , emergency medicine , surgery , health services , population , environmental health , social science , sociology
Objective To understand provider perceptions and experiences following training in the use of a condom‐catheter uterine balloon tamponade (UBT) as second‐line treatment for uncontrolled postpartum hemorrhage (PPH) in health facilities in Kenya. Methods As part of a qualitative study, interviews of facility‐based providers who had managed PPH following comprehensive PPH training were conducted between February and April 2014. Facilities were purposively sampled to represent a range of experience with UBT, facility size, and geography. Interviews continued until thematic saturation was achieved. Interview transcripts were analyzed for themes. Results Overall, 68 providers from 29 facilities were interviewed, of whom 31 reported experience with UBT placement (25 midwives, 2 clinical officers, 4 medical officers). Qualitative analysis revealed several major themes. Providers used UBT appropriately within the PPH algorithm, although the timing and clinical severity of patients varied. UBT was most commonly used when bleeding was unresponsive to uterotonics, hysterectomy was unavailable, and referral times long. Providers reported that bleeding was arrested following UBT use in all except one patient, who had a suspected coagulopathy. Most providers described UBT as technically easy to use, although three described initial balloon displacement. Conclusion UBT has been readily accepted by providers at all levels of training and is being incorporated into the existing PPH management algorithm in Kenya.