POSTPARTUM HEMORRAGE
Is there an evolving treatment regimen?
Uterotonics, Bakri, Jada
Postpartum Hemorrhage (PPH)
Earlier this year, the World Health Organization (WHO) had a summit on PPH, the “leading cause of maternal mortality worldwide”. As we have discussed in an earlier post on maternal mortality, PPH is one of the preventable causes of maternal death. Obstetric providers ought to have a mentally ready approach to those at increased risk of PPH and to quickly respond to those suffering this complication. Fortunately there are new technologies that assist us in preventing the consequences of PPH, the newest of which is the Jada vacuum tamponade device. While most of us are quite familiar with uterotonics (misoprostol, methyl ergonovine, oxytocin, et al), and the antifibrinolytic, tranexamic acid, and the Bakri balloon tamponade device, the Jada is new to some and not available to all providers. Each Labor and Delivery unit must make its own decision on purchasing new devices, some considerations in addition to cost, include effectiveness and ease of use. Here we make an argument for inclusion of the Jada. In an assessment of the “pros and cons”, first the cons of the Jada. It certainly is more costly than merely using oxytocin or methyl ergonovine alone. And, while some of our colleagues have made an argument for use of the Jada very early in the management of PPH, few would argue its use prior to the readily available uterotonics. While the Jada is approximately twice the cost of the Bakri, at least one study (Oregon Health and Science Univ.) shows an overall cost analysis with a more than $2,000 savings with the Jada. A Poster presentation in the Gray Journal (Amer. J. of Ob Gyn) Feb 10, 2023, Vol 228, Issue 1, Supp S600, concluded that the Jada (compared to Bakri) led to fewer adverse outcomes and decreased costs. The pros of the Jada: placement of the Bakri can be cumbersome, placement of the Jada, even after minimal instruction, is relatively, quite simpler, and while simpler to place, anecdotally, the Jada has its positive effect much more rapidly.
