title: A qualitative assessment of the impact of a uterine balloon tamponade package on decisions regarding the role of emergency hysterectomy in women with uncontrolled postpartum haemorrhage in Kenya and Senegal.
abstract: OBJECTIVE
  To assess the impact of a every second matters for mothers and babies uterine balloon tamponade package (ESM-UBT) on provider decisions regarding emergency hysterectomy in cases of uncontrolled postpartum haemorrhage (PPH).
  
  
  METHODS
  Qualitative assessment and analysis of a subgroup extracted from a larger database that contains all UBT device uses among ESM-UBT trained health providers.
  
  
  METHODS
  Health facilities in Kenya and Senegal with ESM-UBT training and capable of performing emergency hysterectomies.
  
  
  METHODS
  All medical doctors who had placed a UBT for uncontrolled PPH subsequent to implementation of ESM-UBT at their facility, and who also had the capabilities of performing emergency hysterectomies.
  
  
  METHODS
  The impact of ESM-UBT on decisions regarding emergency hysterectomy in cases of uncontrolled PPH.
  
  
  RESULTS
  30 of the 31 medical doctors (97%) who fulfilled the inclusion criteria were independently interviewed. Collectively the interviewed medical doctors had placed over 80 UBT devices for uncontrolled PPH since ESM-UBT implementation. All 30 responded that UBT devices immediately controlled haemorrhage and prevented women from being taken to emergency hysterectomy. All 30 would continue to use UBT devices in future cases of uncontrolled PPH.
  
  
  CONCLUSIONS
  These preliminary data suggest that following ESM-UBT implementation, emergency hysterectomy for uncontrolled PPH may be averted by use of uterine balloon tamponade.
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Anna Alaska
authors.initials: AA
authors.lastname: Pendleton
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Abirami
authors.initials: A
authors.lastname: Natarajan
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Roy
authors.initials: R
authors.lastname: Ahn
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Brett D
authors.identifier: http://orcid.org/0000-0002-5049-1798
authors.initials: BD
authors.lastname: Nelson
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Melody J
authors.initials: MJ
authors.lastname: Eckardt
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Burke
mesh_terms: D000066491:Clinical Decision-Making; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D007630:Kenya; D009774:Obstetrics / Q000193:education; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D012675:Senegal; D058738:Uterine Balloon Tamponade
keywords: Postpartum hemorrhage; emergency hysterectomy; maternal mortality; uterine balloon tamponade