title: PPH Butterfly: a novel device to treat postpartum haemorrhage through uterine compression.
abstract: OBJECTIVE
  Postpartum haemorrhage (PPH) is a significant cause of maternal morbidity and mortality. The most common cause is an inability of the uterus to contract adequately after childbirth. In bimanual compression (BMC), one hand is placed within the vagina and the other hand is on the abdominal wall to compress the uterus. It is effective, but very uncomfortable for the woman. We designed a device that could replicate BMC without inserting a hand vaginally, therefore being less invasive. It could also help in diagnosing the source of the bleeding.
  
  
  METHODS
  Mixed methods, combining an iterative design process with input from clinicians in simulations, and focus groups of clinicians and consumers.
  
  
  METHODS
  Department of Women's and Children's Health and Department of Medical Physics and Clinical Engineering, University of Liverpool, UK.
  
  
  METHODS
  A multidisciplinary team developed the design, using an obstetric manikin. Clinician and consumer groups also gave input on the concept and design. A healthcare product company and prototype manufacturer provided input into strategy, design and manufacture.
  
  
  RESULTS
  The PPH Butterfly is a single piece, plastic medical device that replicates BMC. It is designed to be easy to use and low-cost and allows for smooth insertion and removal. It is acceptable to clinicians and consumers and performs well in tests.
  
  
  CONCLUSIONS
  This is the first device designed to replicate BMC while being less invasive. It could potentially be an effective form of PPH management, while also diagnosing the source of the bleeding. The device will now be tested in humans.
authors.affiliation: Women's and Children's Health, University of Liverpool , Liverpool , UK.
authors.forename: Caroline
authors.identifier: 0000-0001-7008-4447
authors.initials: C
authors.lastname: Cunningham
authors.affiliation: Medical Physics and Clinical Engineering, Royal Liverpool and Broadgreen University Hospitals NHS Trust , Liverpool , UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Watt
authors.affiliation: Women's and Children's Health, University of Liverpool , Liverpool , UK.
authors.forename: Nasreen
authors.initials: N
authors.lastname: Aflaifel
authors.affiliation: Interplex Select Moulds , High Wycombe , UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Collins
authors.affiliation: Women's and Children's Health, University of Liverpool , Liverpool , UK.
authors.forename: Dot
authors.initials: D
authors.lastname: Lambert
authors.affiliation: EPS Ltd , Wirral , UK.
authors.forename: John
authors.initials: J
authors.lastname: Porter
authors.affiliation: University of Manchester School of Nursing Midwifery and Social Work , Manchester , UK.
authors.forename: Tina
authors.initials: T
authors.lastname: Lavender
authors.affiliation: Royal Liverpool and Broadgreen University Hospitals NHS Trust , Liverpool , UK.
authors.forename: Tony
authors.initials: T
authors.lastname: Fisher
authors.affiliation: Women's and Children's Health, University of Liverpool , Liverpool , UK.
authors.forename: Andrew
authors.identifier: 0000-0002-1909-337X
authors.initials: A
authors.lastname: Weeks
keywords: Bimanual Compression; PPH Butterfly; Postpartum Haemorrhage; Treatment; Uterine Atony