A case series of post-partum haemorrhage managed using Ellavi uterine balloon tamponade in a rural regional hospital.

Gerhard B Theron,Vulikaya Mpumlwana

doi:10.4102/safp.v63i1.5266

Gerhard B Theron, Vulikaya Mpumlwana

Open Access

https://doi.org/10.4102/safp.v63i1.5266

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Abstract

Uterine balloon tamponade (UBT) should be attempted once emergency measures have been applied and medical treatment for post-partum haemorrhage (PPH) resulting from an atonic uterus has failed. Sinapi Biomedical (Pty) Ltd developed the Ellavi UBT, a free-flow pressure-controlled UBT unit. The device is affordable for use in lesser-resourced countries. A case series of Ellavi UBT used by medical officers in a rural regional hospital without specialist supervision was conducted. This case series was conducted in St Elizabeth’s Hospital in Lusikisiki, South Africa. The hospital serves as the regional hospital for the Ingquza Hill Subdistrict in the Eastern Cape Province. The Nelson Mandela Academic Hospital (NMAH) in Mthatha is the tertiary referral hospital. Workshops were conducted on the use of Ellavi UBT, and devices were made freely available to the hospital. The case series included 10 patients. Six patients delivered by caesarean section, and four had normal vertex deliveries. All patients had additional oxytocin infusions, and eight patients received misoprostol. Following the insertion and inflation of the Ellavi UBT, the PPH stopped in seven patients, was much reduced in one patient and reduced in one patient. In one case, the Ellavi UBT had no effect on the bleeding. All 10 patients were referred to the NMAH. All patients in the case series had good outcomes. The insertion of the Ellavi UBT and subsequent referral proved to be feasible in a rural regional hospital. All patients included in the case series arrived at the referral hospital and had a good outcome.

Highlights

In South Africa, haemorrhage was the second most important direct cause of maternal deaths in the 2014–2016 triennial report by the National Committee for Confidential Enquiries into Maternal Deaths.[1]
Ellavi Uterine balloon tamponade (UBT) devices were made freely available to the hospital
No cases were reported where the Ellavi UBT was taken from the sterile package with intention to use but not used

Summary

Introduction

In South Africa, haemorrhage was the second most important direct cause of maternal deaths in the 2014–2016 triennial report by the National Committee for Confidential Enquiries into Maternal Deaths.[1] Fawcus[2] determined the outcomes of women with obstetric haemorrhage that required referral to the level of care. Obstetric haemorrhage caused 624 deaths, with 128 women requiring referral. Of these women, 25 (20.8%) died whilst waiting for ambulance transport and a further 17 (14.2%) during ambulance transfer. The mean waiting time was 3.7 h, and the range was 1–11 h. An additional measure to reduce blood loss is urgently required when women require referral

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