Abstract
Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and mortality world-wide. Although declining globally, maternal mortality is on the rise in the United States. Since uterine balloon tamponade (UBT) has been shown to be safe as well as highly effective in arresting PPH and halting shock progression, this study sought to clarify the practice and perceptions of UBT use among midwives and family physicians in the United States. A cross-sectional 12-item survey on the practice, experiences and perceptions of uterine balloon tamponade utilization for PPH management was conducted among midwives and family physicians that perform deliveries in the United States. The survey settings were one family medicine and two midwifery national conferences in the United States. One hundred and ninety-seven midwives (164; 83.2%) and family physicians (33; 16.8%) completed the surveys. The 197 providers had previously cared for a mean of 6.0 (SD= 18.8) uncontrolled PPH cases each, over the course of their career till date. Eighty (40.6%) of the 197 respondents had been involved with at least one hemorrhaging woman in which a UBT was placed, but only 13 (7.9%) of the 164 midwives and 6 (18.2%) of the 33 family physicians had ever placed a UBT device themselves. One hundred and thirty-one (73.6%) of 178 providers desired training on use of UBT. Midwives and family physicians in the United States care for women with uncontrolled PPH, however, infrequently place a UBT device. Most midwives and family physicians would like training on uterine balloon tamponade. Key words: Uterine balloon tamponade, post-partum hemorrhage, maternal hemorrhage, emergency obstetric care.
Highlights
Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and mortality worldwide
While many low and middleincome countries have made considerable strides to reduce their maternal mortality ratios (MMR) over the past two decades, the MMR in the United States has worsened by 136% over the past 20 years (World Health Organization, 2014)
Appropriate utilization of uterine balloon tamponade was defined as uterine placement of a UBT in each case of uncontrolled post-partum hemorrhage
Summary
Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and mortality worldwide. It is estimated that PPH is responsible for 130,000 deaths and 2.6 million injured women across the globe annually (AbouZahr, 2003; World Health Organization, 2012; MacDorman et al, 2013). While many low and middleincome countries have made considerable strides to reduce their maternal mortality ratios (MMR) over the past two decades, the MMR in the United States has worsened by 136% over the past 20 years (World Health Organization, 2014). The incidence of PPH in the United States has increased by over 30% since 2004 and today. It is notable that one in ten women with PPH will fail first line therapies and are classified as having uncontrolled PPH (Ononge et al, 2016)
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