Intra-uterine tamponade for post- partum hemorrhage management A controlled randmised trial in Vietnam ? Ho Chi Minh Ville, April 2013 Working group: -Vietnam:

Slides:



Advertisements
Similar presentations
Leading Change From the Front Line In Afghanistan USAID Health Care Improvement (HCI) Project University Research Co., LLC Center for Human Services.
Advertisements

Nahida Chakhtoura, M.D..  Postpartum hemorrhage (PPH): leading cause of maternal mortality worldwide  Prevalence rate: 6%  Africa has highest prevalence.
Postpartum Hemorrhage(PPH) 产后出血 林建华. Major causes of death for pregnancy women ( maternal mortality) Postpartum hemorrhage ( 28%) heart diseases pregnancy-induced.
Postpartum Hemorrhage Christopher R. Graber, MD Salina Women’s Clinic 21 Feb 2012.
Postpartum Hemorrhage (PPH) and abnormalities of the Third Stage Sept 12 – Dr. Z. Malewski.
Postpatrum Hemorrhage and Third Stage Emergencies
Obstetrical Simulator Curriculum Sarah Price, MD Amanda Pauley, MD MU Dept. of Obstetrics and Gynecology JCESOM Academy of Medical Educators.
Postpartum Hemorrhage HEE HEE That’s the only fake blood I could manage!!! Too messy. Jessi Goldstein MD MCH Fellow September 7,
Maternal Affinity Group September 25, Objectives Name at least 3 of the core elements of Postpartum Hemorrhage Identify the need for a risk factor.
Major Obstetric haemorrhage Miss Melanie Tipples.
Misoprostol for PPH: An Update on Gynuity’s collaborative body of research An Update: March 2008.
MANAGEMENT OF POST PARTUM HEAMORRHAGE BY YOLAM KAMEME (MZIMBA SOUTH DISTRICT HOSPITAL) RONALD CHAGOMA (RUMPHI DISTRICT HOSPITAL) EMMANUEL NYIRENDA (NKHOTAKOTA.
Etiology and management of uterine atony Dr. Vedran Stefanovic, docent Specialist in OB/GYN, Maternal and Fetal Medicine Helsinki University Central Hospital.
ROLE OF MODIFIED B-LYNCH SUTURE IN ATONIC PPH IN CESAREAN SECTION
ALTERNATIVE METHODS FOR MANAGEMENT OF ATONIC POSTPARTUM HAEMORRHAGE
Umbilical cord clamping in term deliveries: the RCOG perspective Dr Anna David Reader and Consultant in Obstetrics and Maternal Fetal Medicine UCL Institute.
PRESENTATION ON SAFETY ISSUES RELEVANT TO HOME BIRTHS AND THE PROFESSIONALS WHO PROVIDE MATERNITY CARE SEPTEMBER 20, 2012 The Maryland Chapter of the American.
Obstetric Haemorrhage Obstetric Emergencies Empangeni Hospital 28th July 2000.
Obstetric Hemorrhage Anne McConville, MD
Introducing balloon tamponade technology in the management of postpartum haemorrhage in Malaysia 1,2,3 Associate Professor Chris Georgiou BSc (Hons) PhD.
Postpartum Haemorrhage. Definitions Primary PPH – blood loss of 500ml or more within 24hours of delivery. Secondary PPH – significant blood loss between.
Post Partum Hemorrhage
OXYTOCIN It is an octapeptide synthesized in hypothalamus and stored in pituitory. Trade name:  Pitocin, Syntocinon(1 amp= 1 ml= 5 IU)
Dr. M Movahedi MD. Dr. M Movahedi MD Balloon tamponade is an effective adjunct in the treatment of severe postpartum hemorrhage secondary to uterine.
Third stage of labour Dr.Roaa H. Gadeer MD.
Active Management of Third Stage of Labor
Obstetric Haemorrhage. Aims To recognise Obstetric Haemorrhage To recognise Obstetric Haemorrhage To practise the skills needed to respond to a woman.
EUropean Project on obstetric Haemorrhage Reduction: Attitudes, Trial, and Early warning System.
Dr Ahmed abdulwahab. Hemorrhage is still one of the leading cause of maternal mortality all over the world DEFINITION Primary post partum hemorrhage.
Medical and Surgical Procedures While in the NASG ©Suellen Miller 2013.
Primary Postpartum Haemorrhage Max Brinsmead MB BS PhD May 2015.
| Africa Regional Meeting on Interventions for Impact in Essential Maternal and Newborn Care, Addis Ababa, Feb 21, 2011 Timing of delivery and induction.
PPH Prevention and Management at Health Facilities Jeffrey M. Smith Asia Regional Technical Director AME Regional Meeting Bangkok March 2010.
Developing Cardiac Rehabilitation in Vietnam Dr Juliette Hussey School of Medicine Trinity College Dublin Ireland.
Vaginal Birth After Cesarean: Is it Still an Option
KBP 06/10 NOSS – more than surveillance. KBP 06/10 To develop a Nordic Obstetric Surveillance System to describe the epidemiology of a variety of serious.
11 New Sexual and Reproductive Health Guidelines and Technologies Sharon Phillips, Lisa Thomas, Lale Say 31 May 2013.
POPPHI – WGI presentations FIGO. 1. Lectures given on prevention & management of PPH that included FIGO/ICM joint statement and active management of the.
{ Postpartum Hemorrhage (PPH) What to know and do Dr. Bruno C. R. Borges Hamilton Health Sciences McMaster University OMA Anesthesia Meeting 2014.
04_DirectorReport_PCC/1 9/2004 Rita Kabra_/1 Access to essential medicines for Maternal and Newborn Health Dr Rita Kabra Making Pregnancy Safer WHO/EDM.
Cook Cervical Ripening Balloon Product information 18Fr, 40 cm Dual 80 ml balloons 100% Silicone Box of 10 J – CRB – or G48149  
© Mark E. Damon - All Rights Reserved This be a Presentation © All rights Reserved.
Evaluating the efficacy of the B-lynch suture and the Bakri balloon, or both, in the treatment of severe post-partum haemorrhage Dr Ashleigh Smith Junior.
CWIUH Bridgette Byrne Senior Lecturer in Obstetrics and Gynaecology, RCSI and CWIUH.
1 |1 | Africa Regional Meeting on Interventions for Impact in Essential Maternal and Newborn Care, Addis Ababa, Feb 21, 2011 WHO Recommendations for the.
Postpartum Hemorrhage
Postpartum Haemorrhage
1 5 th World Conference on Virology, December th 2015, Atlanta,USA Chaste KARANGWA 1, Eugene RUGIRA 1, Placidie MUGWANEZA 1, Helene Badini 3, Fabian.
Implementing Quality: An introduction to Quality Standards Dr Françoise Cluzeau, Associate Director NICE International Maternal Quality Standards in the.
Towards Global Eminence K Y U N G H E E U N I V E R S I T Y j 내과 R2 이지영.
Chapter 33 Postpartum Complications Mosby items and derived items © 2012, 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
Maternal Mortality Assistant Professor Dr. Batool A. Gh. Yassin Depart. Of Community & family Medicine Baghdad College of Medicine 2014.
Postpartum hemorrhage
Emergency Obstetric and Newborn Care (EmONC)
Post Partum Haemorrhage - Dr Thomas Carins
UOG Journal Club: July 2016 Ability of a preterm surveillance clinic to triage risk of preterm birth: a prospective cohort study J Min, HA Watson, NL Hezelgrave,
MOVING TO ACTION: Identifying Responses.
The Occasional Retained Placenta: Now What Happens?
Postpartum Hemorrhage
Maternal Health in Zambia
Management of Obstetric Hemorrhage Not Caused by Uterine Atony: Policy Implications for Safe Motherhood Based on Pilot Studies of the NASG in Egypt and.
UOG Journal Club: January 2018
Woman’s Health and Midwifery Nursing Dep. Faculty of Nursing
mLearning in the DR Congo
PROPPR Transfusion of Plasma, Platelets, and Red Blood Cells in a 1:1:1 vs a 1:1:2 Ratio and Mortality in Patients With Severe Trauma. 
Team training in emergency obstetrics
Unusual Presentation of Placenta Increta
Partograph Dr Ban Hadi F.I.C.O.G
Surgical safety checklist trial
Presentation transcript:

Intra-uterine tamponade for post- partum hemorrhage management A controlled randmised trial in Vietnam ? Ho Chi Minh Ville, April 2013 Working group: -Vietnam: Dr To Van Trung - France: Dr Alexandre Dumont

Background Maternal mortality – Global health problem OMD for 2015 ( ) ↘ ¾ maternal mortality in the World

Post-partum hemorrhage First cause of maternal mortality Maternal mortality remain stable – In countries with high MM ratios – Despite the standardization of treatments « New technology »: intra-uterine tamponade – WHO 2009 – « Should intrauterine balloon or condom tamponade be offered in the treatment of PostPartum Haemorrhage? » – Review of observational studies – Success rate : 71% à 100%

Intra-uterine tamponade

GEORGIOU C. Intraluminal pressure readings during the establishment of a positive 'tamponade test' in the management of postpartum haemorrhage. BJOG 2010;117:

Problem The device « condom-catheter » may have the same effectivness as « Bakri » and less expensive Observational studies show a high success rate, but: – low level of evidence – Publication biais – Need to compare with a standard of care (control)

Trial in Benin and Mali (Africa) Objective Méthodology Key data How should be included? How should we include? Randomization Outcomes After inclusion ?

Objective Test the effectivness of the intra-uterine tamponade in term of reducing severe maternal morbidity 2 countries: Benin et Mali 3 hospitals by country

Methods Multicentric controlled randomized trial. Arm A :Misoprostol (5 tablets µg) sub- lingual or intra-rectal + « condom-catheter » intra-uterine tamponade. Arm B :Misoprostol (5 tablets µg) sub- lingual or intra-rectal.

Key data Study duration: 12 months Study attending for each patient : between 24 hours and 15 days. Number of patients needed : 55 patients in each arm

Who should we inlcude? Patients with uterine atony resistant to oxytocin Are not inlcuded: – Cesarean delivery – Contraindication or allergy to prostaglandins – Allergy to latex – Chorioamniotis – Uterine rupture – Placenta accreta

How should we include? The most difficult step Randomization in emergency situation Verbal consent (written consent after) Management of PPH simultaneously Need: – a third person (to assist the clinician) a coordinator to centralize the randomization

Outcomes Primary outcome Recourse to surgery intervention: uterine aretry ligation via laparotomy and/or hysterectomy. Secondary outcomes – Hemorrhage > 1000 mL. – Transfusion. – Referral to adult ICU. – Maternal death

What’s happen after inclusion? The same day: – The management of the PPH is the priority – Note each step of the management in the clinical record – Collect the data using the standardized the questionnaire

– During hospitalization – Then 15 days after hospital dischrage (phone call) – Collect information on PPH, treatment, adverse effects of the treatments, maternal and perinatal outcomes Patient monitoring

Declare severe adverse effects Severe adverse effects are : - life-threatening complications - Sustainable inacapacity -choc (allergy) - endometritis - new hospitalization - maternal death

Questions Do you use intra-uterine tamponade in Vietnam? « condom-catheter » is relevant in Vietnam? A controlled randomized trial is feasible?

Training group

material Foley catheter Condom One-liter bag of solute Needleless suture 50-mL syringe Obturator

Assembly of the condom-catheter

Steps to assemble 1.Place the condom on the catheter. 2.Attach this the condom to the catheter using a thread 3.Connect the seringue to the catheter. 4.Test the seal. 5.Place the catheter in the intra-uterine position. 6.Begin filling manually the condom until bleeding stops. 7.Hold the catheter in place in the uterus using a vaginal pack.

Place the condom on the catheter

Attach the condom to the catheter 1234

Place the catheter in the intra-uterine position

Fill the condom: The condom is inflated in increments of 250 mL of solute using a 50 mL syringe without exceeding 1000 mL. After each increment was added, if bleeding continued after five minutes, the clinician continued filling the condom until the maximum level was reached. If successful, vaginal packing to prevent accidental removal of the condom catheter, and the Foley catheter is clamped.

Alternative method to fill the condom End of the Foley catheter Adapter to the solute pack End of the infusion tubing

Manual filling with the solute pack 1 minute OpenClosed

Practical aspects 1 person « aspectic » – Assmble the device – Place the catherter in the intra-uterin position – Keep the catheter in the good position during filling – Vaginal packing 1 person non « aseptic » – Filling manually the condom – Team coordination

Monitoring Success in 15 minutes Sucess criteria +++ – Good hemodynamic (Aterial pressure, heart rate) – Vaginal bleeding – DO NOT PRESS THE FUNDAL OF THE UTERUS

Stop the tamponade. When? Duration of the tamponade – Minimum 6 hours – Maximum 12 hours (to prevent the sepsis) – Stop the tamponade when the team is complete How should we stop the tamponade – Delete half of the volume – Wait 1 hour – Then delete the remaining solute and the balloon

Condom-catehter Let us go …