Haemorrhage from a partially detached extrauterine placenta can be catastrophic. We describe a novel surgical technique using a Foley's catheter tourniquet, applied between the partially detached and attached portions of the placenta of an irremovable placenta to control blood loss. It may be left in situ and removed at repeat laparotomy. The catheter tourniquet has equally shown utility with a removable placenta. Applied as a temporary tourniquet around structures surrounding the implantation site, the technique enables placenta removal with minimal haemorrhage. We report use of this surgical technique with good outcomes.

A document by Kyungu Kime. Click on the document to view its contents.

Objective To assess the perception, knowledge, and practices regarding maternal perception of fetal movements (FMs) among women and their healthcare providers in a low-resource setting. Design Qualitative study. Setting The maternity unit of Mnazi Mmoja Hospital, Zanzibar, Tanzania. Population Pregnant and postpartum women, and health providers. Methods Semi-structured interviews, questionnaires and focus group discussions were conducted with 45 Zanzibar women (18 antenatal, 28 postpartum) and 28 health providers. Main outcome measures Descriptive and thematic analyses were conducted to systematically extract subthemes within four main themes 1) knowledge/awareness, 2) behavior/practice, 3) barriers, and 4) improvements. Results Within the main themes it was found that 1) Women were instinctively aware of (ab)normal FM-patterns and healthcare providers had adequate knowledge about FMs. 2) Women often did not know how to monitor FMs or when to report concerns. There was inadequate assessment and management of (ab)normal FMs. 3) Women did not feel free to express concerns. Healthcare providers considered FM-awareness among women as low and unreliable; lack of staff, time and space for FM-education, and no protocol for FM-management. 4) Women and health providers recognized the need for education on assessment and management of (ab)normal FMs. Conclusion Women expressed FMs in an adequate way and perceived abnormalities of these movements better than assumed by health providers. There is a need for more evidence on the effect of improving knowledge and awareness of FMs in order to construct evidence-based guidelines for low resource settings.

Objectives: to evaluate the effectiveness of uterine tamponade devices for atonic refractory postpartum haemorrhage (PPH) after vaginal birth, and the effect of including uterine tamponade devices in institutional protocols. Search strategy: databases in PubMed, EMBASE, CINAHL, LILACS and POPLINE. Study selection: randomised and non-randomised comparative studies. Outcomes: composite outcome including surgical interventions (artery ligations, uterine compressive sutures or hysterectomy) or maternal death, and hysterectomy. Results: all four included studies were at high risk of bias. The certainty of evidence rated as very low to low. One randomised study measured the effect of the the condom-catheter balloon compared to standard care and found unclear results for the composite outcome (RR 2.33, 95%CI 0.76-7.14) and hysterectomy (RR 4.14, 95%CI 0.48-35.93). Three comparative studies assessed the effect of including UBTs in institutional protocols. A stepped-wedge study suggested an increase in the composite outcome (RR 4.08, 95%CI 1.07-15.58), and unclear results for hysterectomy (RR 4.38, 95% CI 0.47-41.09) with the use of the condom-catheter or surgical glove balloon. One non-randomised study showed unclear effects on the composite outcome (RR 0.33, 95%CI 0.11-1.03) and hysterectomy (RR 0.49, 95%CI 0.04-5.38) after the inclusion of Bakri balloon. The second non-randomized study found unclear effects on the composite outcome (RR 0.95, 95%CI 0.32-2.81) and hysterectomy (RR 1.84, 95%CI 0.44-7.69) after the inclusion of Ebb or Bakri balloon. Conclusions: the effect of uterine tamponade devices for the management of atonic refractory PPH after vaginal delivery is unclear, as is the role of the type of device and the setting.

Labour induction with a cervical Foley catheter balloon is safer than pharmacological methods, particularly with previous caesarean section, fetal compromise or limited monitoring facilities. Amniotomy is associated with setting-specific risks. To extend balloon retention until labour is established thus avoiding pharmacological agents or amniotomy, we have developed a novel method of variable weighting of the balloon catheter according to the cervical status. When the cervix is too dilated to retain a single balloon, two Foley balloons are inserted side by side at the same level above the cervix.

Objectives: to describe available uterine tamponade devices for the management of postpartum haemorrhage, and to evaluate its effectiveness as a treatment of refractory PPH. Search strategy: Databases searched included PubMed, EMBASE, CINAHL, LILACS and POPLINE. Study selection: To describe uterine tamponade devices any type of study was included; only randomised and non-randomised comparative studies were included to assess the effectiveness of uterine tamponade devices. Outcomes: The primary outcomes were: a composite outcome including surgical interventions or maternal death, and hysterectomy. Results: Twenty-four types of tamponade devices were identified. The Bakri and the condom-catheter balloon were the most frequently reported. One randomised controlled trial suggests non-significant increases in the composite outcome (RR 2.33, 95%CI 0.76-7.14) and hysterectomy (RR 4.14, 95%CI 0.48-35.93) associated with the condom-catheter balloon vs. no device. Another RCT suggests a non-significant reduction in the composite outcomes (RR 0.60; 95%CI 0.16-2.31) and hysterectomy (RR=0.5; 95%CI 0.05-5.25) with the Bakri balloon vs the condom-catheter balloon. A stepped-wedge study suggests an increase in the composite outcome (RR 4.08, 95%CI 1.07-15.58), and a non-significant increase in hysterectomies (RR 4.38, 95% CI 0.47-41.09) associated with the introduction of condom-catheter or surgical glove balloon into clinical settings. Conversely, non-randomised studies showed a non-statistically significant reduction (RR=0.61, 95%CI 0.27-1.40) in the composite outcome and no effect on hysterectomy associated with the use of the Bakri balloon. Conclusions: The effect of UBT for the management of atonic refractory PPH after vaginal delivery is unclear, as is the role of the type of device and the setting.

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