{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T14:06:26Z","timestamp":1790690786812,"version":"4.1.0"},"reference-count":26,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2022,3,16]],"date-time":"2022-03-16T00:00:00Z","timestamp":1647388800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the impact of introducing a uterine balloon tamponade (ESM\u2010UBT) device for managing severe postpartum hemorrhage (PPH), mainly due to uterine atony, in health facilities in India on the rates of PPH\u2010related maternal death and invasive procedures for PPH control.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used a quasi\u2010experimental, difference\u2010in\u2010difference (DID) design to compare changes in the rates of a composite outcome (PPH\u2010related maternal death and\/or artery ligation, uterine compression sutures, or hysterectomy) among women delivering in nine intervention facilities compared with those delivering in two control facilities, before and after the introduction of ESM\u2010UBT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study sample included 214\u2009123 deliveries (<jats:italic>n\u00a0=<\/jats:italic>\u00a078\u2009509 before ESM\u2010UBT introduction; <jats:italic>n\u00a0=<\/jats:italic>\u00a047\u2009211 during ESM\u2010UBT introduction; and <jats:italic>n\u00a0=<\/jats:italic>\u00a088\u2009403 after ESM\u2010UBT introduction). After introduction of ESM\u2010UBT, there was a significant decline in the rate of the primary composite outcome in intervention facilities (21.0\u201311.4 per 10\u00a0000 deliveries; difference \u22129.6, 95% confidence interval \u221214.0 to \u22125.4). Change in the rate of the primary composite outcome was not significant in control facilities (11.7\u201317.2 per 10\u00a0000 deliveries; difference 5.4, 95% confidence interval \u22123.9 to 14.9). DID analyses showed there was a significant reduction in the rate of the primary composite outcome in intervention facilities relative to control facilities (adjusted DID estimate \u221215.0 per 10\u00a0000 points, 95% confidence interval \u221223.3 to \u22126.8; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.005).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Introduction of the ESM\u2010UBT in health facilities in India was associated with a significant reduction in PPH\u2010related maternal death and\/or invasive procedures for PPH control.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ijgo.14156","type":"journal-article","created":{"date-parts":[[2022,2,25]],"date-time":"2022-02-25T11:27:51Z","timestamp":1645788471000},"page":"466-473","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Impact of the introduction of a low\u2010cost uterine balloon tamponade (<scp>ESM\u2010UBT<\/scp>) device for managing severe postpartum hemorrhage in India: A comparative before\u2010and\u2010after study"],"prefix":"10.1002","volume":"159","author":[{"given":"Thomas F.","family":"Burke","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"Harvard T.H. Chan School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Poonam V.","family":"Shivkumar","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Mahatma Gandhi Institute of Medical Sciences  Sewagram India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Preeti","family":"Priyadarshani","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology All India Institute of Medical Sciences  Gorakhpur India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorraine","family":"Garg","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agustin","family":"Conde\u2010Agudelo","sequence":"additional","affiliation":[{"name":"Perinatology Research Branch, Division of Obstetrics and Maternal\u2010Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, US Department of Health and Human Services National Institutes of Health  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moytrayee","family":"Guha","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Brown School of Public Health  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,3,16]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(14)70227-X"},{"key":"e_1_2_9_3_1","volume-title":"Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division","year":"2019"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-020-00990-z"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.12096"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12636"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-016-1054-1"},{"key":"e_1_2_9_8_1","first-page":"755","volume-title":"Williams Obstetrics","author":"Cunningham F","year":"2018"},{"key":"e_1_2_9_9_1","volume-title":"Recommendations for the Prevention and Treatment of Postpartum Haemorrhage","author":"WHO","year":"2012"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.13028"},{"key":"e_1_2_9_11_1","unstructured":"WHO recommendation on uterine balloon tamponade for the treatment of postpartum haemorrhage.World Health Organization;2021. 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