Postpartum infection, pain and experiences with care among women treated for postpartum hemorrhage in three African countries: A cohort study of women managed with and without condom-catheter uterine balloon tamponade

We aimed to determine the risk of postpartum infection and increased pain associated with use of condom-catheter uterine balloon tamponade (UBT) among women diagnosed with postpartum hemorrhage (PPH) in three low- and middle-income countries (LMICs). We also sought women's opinions on their ove...

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Published in:	PloS one Vol. 16; no. 2; p. e0245988
Main Authors:	Anger, Holly A, Durocher, Jill, Dabash, Rasha, Hassanein, Nevine, Ononge, Sam, Burkhardt, Gillian, Frye, Laura J, Diop, Ayisha, Beye Diop, Seynabou Bop Moctar, Darwish, Emad, Ramadan, Mohamed Cherine, Kayaga, Juliana, Charles, Dyanna, Gaye, Alioune, Eckardt, Melody, Winikoff, Beverly
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 08-02-2021 Public Library of Science (PLoS)
Subjects:	Antibiotics Beliefs, opinions and attitudes Biology and Life Sciences Birth Care and treatment Catheters Childbirth & labor Cohort analysis Complications and side effects Condoms Cross infection Earth Sciences Editing Ethics Funding Global health Gynecology Health aspects Health risks Hemorrhage Infections Maternal mortality Medical instruments Medicine Medicine and Health Sciences Methodology Nosocomial infections Obstetrics Pain Pain management Postpartum Public health Puerperium Research and Analysis Methods Research ethics Reviews Risk factors Science and technology Social Sciences Surgery Surgical equipment Tamponade Urinary tract infections Uterus Vagina Women patients Womens health Senegal Uganda Egypt New York New Mexico United States > US Massachusetts Kampala Uganda Alexandria Egypt
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Summary:	We aimed to determine the risk of postpartum infection and increased pain associated with use of condom-catheter uterine balloon tamponade (UBT) among women diagnosed with postpartum hemorrhage (PPH) in three low- and middle-income countries (LMICs). We also sought women's opinions on their overall experience of PPH care. This prospective cohort study compared women diagnosed with PPH who received and did not receive UBT (UBT group and no-UBT group, respectively) at 18 secondary level hospitals in Uganda, Egypt, and Senegal that participated in a stepped wedge, cluster-randomized trial assessing UBT introduction. Key outcomes were reported pain (on a scale 0-10) in the immediate postpartum period and receipt of antibiotics within four weeks postpartum (a proxy for postpartum infection). Outcomes related to satisfaction with care and aspects women liked most and least about PPH care were also reported. Among women diagnosed with PPH, 58 were in the UBT group and 2188 in the no-UBT group. Self-reported, post-discharge antibiotic use within four weeks postpartum was similar in the UBT (3/58, 5.6%) and no-UBT groups (100/2188, 4.6%, risk ratio = 1.22, 95% confidence interval [CI]: 0.45-3.35). A high postpartum pain score of 8-10 was more common among women in the UBT group (17/46, 37.0%) than in the no-UBT group (360/1805, 19.9%, relative risk ratio = 3.64, 95% CI:1.30-10.16). Most women were satisfied with their care (1935/2325, 83.2%). When asked what they liked least about care, the most common responses were that medications (580/1511, 38.4%) and medical supplies (503/1511, 33.3%) were unavailable. UBT did not increase the risk of postpartum infection among this population. Women who receive UBT may experience higher degrees of pain compared to women who do not receive UBT. Women's satisfaction with their care and stockouts of medications and other supplies deserve greater attention when introducing new technologies like UBT.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-News-1 ObjectType-Feature-3 content type line 23 Competing Interests: The authors have declared that no competing interests exist.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0245988