{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T12:38:22Z","timestamp":1777811902498,"version":"3.51.4"},"reference-count":28,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2024,5,30]],"date-time":"2024-05-30T00:00:00Z","timestamp":1717027200000},"content-version":"unspecified","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill & Melinda Gates Foundation","doi-asserted-by":"crossref","award":["INV-42351"],"award-info":[{"award-number":["INV-42351"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2024,5,3]]},"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Postpartum haemorrhage (PPH) remains the leading cause of maternal mortality and morbidity globally. Innovative PPH management tools have emerged using suction and sponge tamponade but currently lack substantial evidence. Broader understanding and collaborative research prioritisation are needed, especially in low-income and middle-income countries (LMICs), where the burden of PPH-related mortality is highest. We aimed to describe the current state of evidence and to solicit stakeholder input to identify research priorities related to emerging tools for PPH management.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We used a four-phase modified Delphi approach to identify research priorities for emerging suction and sponge tools. In phase 1, we conducted a literature review and key informant interviews (KIIs) with 19 stakeholders. In phase 2, we distributed an online survey, receiving 66 responses. In phase 3, we virtually convened an expert panel of stakeholders (n=24) and a separate midwife-only focus group to discuss preliminary results and draft research questions. In phase 4, we surveyed our expert panel (n=37) for prioritisation of research questions. Surveys were disseminated via Research Electronic Data Capture while KIIs and the expert convening were held virtually.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Participants included clinicians, researchers, policy-makers, funders and tool developers from high-income and LMIC settings. The prioritisation process narrowed our focus from six tools to four, all of which were top-ranked priorities in phase 4. Stakeholders emphasised efficacy research in comprehensive emergency obstetric and newborn care facilities. Stakeholders stressed the importance of understanding adverse event risks. The urgency in conducting research on cost, provider ease of use and acceptability and patient experience differed between individuals from high-income versus LMIC settings.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>All four tools prioritised in this process have the potential to improve PPH management in LMICs. A coordinated research agenda is necessary to confirm safety and efficacy and to determine which tools are most appropriate for specific LMIC settings.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjph-2023-000113","type":"journal-article","created":{"date-parts":[[2024,5,30]],"date-time":"2024-05-30T18:56:02Z","timestamp":1717095362000},"page":"e000113","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Global research priorities for intrauterine suction and sponge tools for postpartum haemorrhage management in low-income and middle-income countries: a modified Delphi approach"],"prefix":"10.1136","volume":"2","author":[{"given":"Dilys","family":"Walker","sequence":"first","affiliation":[{"name":"Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, USA"},{"name":"Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3206-8707","authenticated-orcid":false,"given":"Linda","family":"Shin","sequence":"additional","affiliation":[{"name":"School of Medicine, California University of Science and Medicine, Colton, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Santos","sequence":"additional","affiliation":[{"name":"Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0026-7464","authenticated-orcid":false,"given":"Elizabeth","family":"Butrick","sequence":"additional","affiliation":[{"name":"Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jill","family":"Durocher","sequence":"additional","affiliation":[{"name":"Gynuity Health Projects, New York, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suellen","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology & Reproductive Sciences, UCSF, San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ribka","family":"Amsalu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology & Reproductive Sciences, UCSF, San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Wanyoro","sequence":"additional","affiliation":[{"name":"Department of OB\/GYN, Kenyatta University, Nairobi, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,5,30]]},"reference":[{"key":"2025083110111285000_2.1.e000113.1","unstructured":"WHO . Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, world bank group and UNDESA\/population division. Geneva: world health organization. 2023."},{"key":"2025083110111285000_2.1.e000113.2","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0041114","article-title":"Identifying regional variation in the prevalence of postpartum haemorrhage: a systematic review and meta-analysis","volume":"7","author":"Calvert","year":"2012","journal-title":"PLoS ONE"},{"key":"2025083110111285000_2.1.e000113.3","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2393-12-108","article-title":"Trends in postpartum hemorrhage from 2000 to 2009: a population-based study","volume":"12","author":"Mehrabadi","year":"2012","journal-title":"BMC Pregnancy Childbirth"},{"key":"2025083110111285000_2.1.e000113.4","doi-asserted-by":"crossref","first-page":"e323","DOI":"10.1016\/S2214-109X(14)70227-X","article-title":"Global causes of maternal death: a WHO systematic analysis","volume":"2","author":"Say","year":"2014","journal-title":"The Lancet Global Health"},{"key":"2025083110111285000_2.1.e000113.5","doi-asserted-by":"crossref","first-page":"1736","DOI":"10.1016\/S0140-6736(18)32203-7","article-title":"Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980\u20132017: a systematic analysis for the global burden of disease study 2017","volume":"392","author":"Roth","year":"2018","journal-title":"The Lancet"},{"key":"2025083110111285000_2.1.e000113.6","doi-asserted-by":"crossref","first-page":"2105","DOI":"10.1016\/S0140-6736(17)30638-4","article-title":"Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-Partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial","volume":"389","author":"Shakur","year":"2017","journal-title":"The Lancet"},{"key":"2025083110111285000_2.1.e000113.7","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1016\/S0140-6736(06)68397-9","article-title":"WHO analysis of causes of maternal death: a systematic review","volume":"367","author":"Khan","year":"2006","journal-title":"The Lancet"},{"key":"2025083110111285000_2.1.e000113.8","doi-asserted-by":"crossref","first-page":"100739","DOI":"10.1016\/j.ajogmf.2022.100739","article-title":"Traditional uterine Tamponade and vacuum-induced uterine Tamponade devices in Obstetrical hemorrhage management","volume":"5","author":"Phillips","year":"2023","journal-title":"American Journal of Obstetrics & Gynecology MFM"},{"key":"2025083110111285000_2.1.e000113.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2008.08.002"},{"key":"2025083110111285000_2.1.e000113.10","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1002\/ijgo.14116","article-title":"FIGO recommendations on the management of postpartum hemorrhage 2022","volume":"157 Suppl 1","author":"Escobar","year":"2022","journal-title":"Int J Gynaecol Obstet"},{"key":"2025083110111285000_2.1.e000113.11","unstructured":"WHO . WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage. World Health Organization. Published online 2012:53, Available: https:\/\/pubmed.ncbi.nlm.nih.gov\/23586122\/ [Accessed 19 Oct 2022]."},{"key":"2025083110111285000_2.1.e000113.12","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.ajog.2019.11.1287","article-title":"Uterine balloon Tamponade for the treatment of postpartum hemorrhage: a systematic review and meta-analysis","volume":"222","author":"Suarez","year":"2020","journal-title":"Am J Obstet Gynecol"},{"key":"2025083110111285000_2.1.e000113.13","unstructured":"WHO . WHO recommendation on uterine balloon Tamponade for the treatment of postpartum haemorrhage. Geneva: world health organization; license: CC BY-NC-SA 3.0 IGO. 2021."},{"key":"2025083110111285000_2.1.e000113.14","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1097\/AOG.0000000000001473","article-title":"Control of postpartum hemorrhage using vacuum-induced uterine Tamponade","volume":"128","author":"Purwosunu","year":"2016","journal-title":"Obstetrics & Gynecology"},{"key":"2025083110111285000_2.1.e000113.15","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1097\/AOG.0000000000004138","article-title":"Intrauterine vacuum-induced hemorrhage-control device for rapid treatment of postpartum hemorrhage","volume":"136","author":"D\u2019Alton","year":"2020","journal-title":"Obstet Gynecol"},{"key":"2025083110111285000_2.1.e000113.16","first-page":"13740","article-title":"Does uterine gauze packing increase the risk of Puerperal morbidity in the management of postpartum hemorrhage during Caesarean section: a retrospective cohort study","volume":"8","author":"Guo","year":"2015","journal-title":"Int J Clin Exp Med"},{"key":"2025083110111285000_2.1.e000113.17","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1097\/AOG.0000000000004135","article-title":"Management of postpartum hemorrhage with a mini-sponge Tamponade device","volume":"136","author":"Rodriguez","year":"2020","journal-title":"Obstet Gynecol"},{"key":"2025083110111285000_2.1.e000113.18","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1515\/jpm-2021-0533","article-title":"Does the use of Chitosan covered gauze for postpartum hemorrhage reduce the need for surgical therapy including hysterectomy? A Databased historical cohort study","volume":"50","author":"Biele","year":"2022","journal-title":"J Perinat Med"},{"key":"2025083110111285000_2.1.e000113.19","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2648.2000.01567.x"},{"key":"2025083110111285000_2.1.e000113.20","unstructured":"Walker D . UCSF Defining Research Priorities Non-Balloon Intrauterine PPH."},{"key":"2025083110111285000_2.1.e000113.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"2025083110111285000_2.1.e000113.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"2025083110111285000_2.1.e000113.23","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.13028"},{"key":"2025083110111285000_2.1.e000113.24","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1002\/ijgo.13963","article-title":"Suction tube uterine Tamponade\u201d for treatment of refractory postpartum hemorrhage: internal feasibility and acceptability pilot of a randomized clinical trial","volume":"158","author":"Cebekhulu","year":"2022","journal-title":"Intl J Gynecology & Obste"},{"key":"2025083110111285000_2.1.e000113.25","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1007\/s13224-017-0963-x","article-title":"Panicker\u2019s vacuum suction Haemostatic device for treating post-Partum haemorrhage","volume":"67","author":"Panicker","year":"2017","journal-title":"J Obstet Gynaecol India"},{"key":"2025083110111285000_2.1.e000113.26","doi-asserted-by":"crossref","first-page":"2258","DOI":"10.1097\/CM9.0000000000002387","article-title":"Bakri balloon Tamponade to treat postpartum hemorrhage","volume":"135","author":"Yang","year":"2022","journal-title":"Chin Med J (Engl)"},{"key":"2025083110111285000_2.1.e000113.27","doi-asserted-by":"crossref","DOI":"10.9745\/GHSP-D-21-00292","article-title":"Global research priorities for understanding and improving respectful care for newborns: A modified Delphi study","volume":"10","author":"Palgi Hacker","year":"2022","journal-title":"Glob Health Sci Pract"},{"key":"2025083110111285000_2.1.e000113.28","doi-asserted-by":"crossref","DOI":"10.1186\/s12978-021-01162-3","article-title":"Formative research to design an implementation strategy for a postpartum hemorrhage initial response treatment bundle (E-MOTIVE): study protocol","volume":"18","author":"Bohren","year":"2021","journal-title":"Reprod Health"}],"container-title":["BMJ Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjph-2023-000113","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T17:11:28Z","timestamp":1756660288000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjpublichealth.bmj.com\/lookup\/doi\/10.1136\/bmjph-2023-000113"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5]]},"references-count":28,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,5,30]]},"published-print":{"date-parts":[[2024,5]]}},"alternative-id":["10.1136\/bmjph-2023-000113"],"URL":"https:\/\/doi.org\/10.1136\/bmjph-2023-000113","relation":{},"ISSN":["2753-4294"],"issn-type":[{"value":"2753-4294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5]]}}}