Kenya: The UBT kit saves mother from postpartum hemorrhage in Migory County

When Josephine* started experiencing labor pains for their last born daughter, her husband quickly suggested that they should leave to the hospital before it was too late. Josephine’s husband shared with us the horrific experience his wife went through during her last delivery which nearly cost Josephine’s life.

Josephine is a 39 years old mother, a resident of Kamagambo in the Migori County. Josephine shared her story about her past deliveries as a mother of 8 children, 5 healthy boys and 3 healthy girls with her youngest being only four months old. In the past, Josephine had never gave birth in a hospital specialising in maternal care. During her previous antenatal care visits, she preferred being attended to by the village midwives (TBAs) until her third delivery where she bled disproportionately. On this occasion, Josephine’s husband had rushed her to the nearby health center where Josephine could receive help. Since then, her husband decided to avoid risking complications and accompanied his wife every time to give birth at the Rongo Sub County Hospital. As a result, Josephine’s following five delivery were done safely in the hospital specialising in maternal care.

However, Josephine’s last delivery did not go well. When Josephine arrived at the Rongo Sub-County Hospital, the mother was informed the baby would not arrive before the next hour. Josephine tried to pass the time by singing and strolling. Josephine was hopeful at the idea of holding her beautiful baby but unexpectedly began bleeding .

The nurse taking care of Josephine shared with us her shock and fear over losing the mother after the baby was born. The nurse mentioned it had happened to her before and she was unwilling to take any chances. The nurse recalls calling for help and using the UBT kit and NASG as an effective emergency method to treat postpartum hemorrhage.

The UBT is a medical device that can be used to treat postpartum hemorrhage when the mother is unresponsive to uterine acting drugs, evacuation or other primary intervention. The UBT kit uses a condom inserted into the uterine cavity using a catheter and then inflated with water. The balloon applies pressure to the walls of the uterus to stop excessive bleeding.

Josephine recalls: “I saw the nurse and the doctor inserting something through my vagina that I had never seen or had of before, it was in different parts but still I couldn’t tell what it was since I was unconscious. The nurse told me that I had bled a lot and somehow the bleeding had not stopped and something had to be done, at this point my husband who was very worried was asked to leave the room.

So many things crossed my mind in a minute, I thought of our situation back home , who would take care of my children if I past away. I asked God to let me live to continue seeing my children grow when they were so young and thought I was dreaming what was happening to me.’’

Josephine says she could have not imagined the children’s life without her. Her husband was a carpenter in the nearby Centre and the family’s income was not consistent enough to guarantee a better future for her children.

Story provided by KMET

*The names have been changed for anonymity

ESM- UBT Saves Mother after a WhatsApp Message

Lilian Musalia, a nurse at Bukura Health Center in Kakamega County was watching TV late in the night with her husband on New Year’s Eve.  At 11.00 p.m. she saw a WhatsApp message from one her colleagues who was on night duty.

“I feel like screaming, I have a mother with PPH and I am all alone with the watchman,” the message read.

This was happening in the background of the protracted 2016 Doctor’s strike that saw several patients die due to lack of specialized services including mothers in need of gynecological attention.

Instinctively, Lilian rushed out of her house to help the nurse at the Health Center. “The patient’s bed was soaked in blood and my colleague looked dazed by the unfolding events. I knew we had to act fast,” she recalls.

A 17 year old patient, had delivered her baby at 2.00 p.m., but experienced heavy bleeding shortly afterwards. She suffered from postpartum hemorrhage (PPH). She was given 40 units of oxytocin, but the bleeding did not stop.

To establish the cause of bleeding, Lilian swiftly examined the client for tears on the vagina, removed blood clots from the uterus and massaged the womb. She soon realized the patient was experiencing PPH.

“I knew UBT was the only solution. We had two UBTs  in the maternity room so I began assembling one. I inserted the balloon and miraculously the bleeding stopped after filling it with only one liter of water,” recounts Lilian.

She left the facility at 2.00 a.m. after referring the patient to Mukumu Mission Hospital where she was transfused with two units of blood. The UBT was removed at 6.00 a.m. and the bleeding had completely stopped.The patient was saved.

Provided by: KMET

ESM-UBT Saves a Woman’s Life in Nyamira County

On November 8, 2015 Everlyne Nyasuguta began to experience stomach contractions and immediately knew she was in labor.

It did not come as a surprise for the 29 year old who had three previous deliveries. She waited until six in the morning to go to the Nyamusi Sub district Hospital in rural Nyamira County. “I stayed in labor for hours, 11 a.m. came and passed…I waited until 5 p.m but I was told I couldn’t deliver yet,” recounts Everlyne.

At around 8 p.m., the nurse who had attended to her earlier that morning came in for the night shift.  He mentioned the baby distressed and Everlyne was not in a position to ‘push’ hard enough for the baby to be delivered. Benard Kilosi, the nursing officer said he induced Everlyne and after a while, she delivered a beautiful baby boy. Then, all the sudden, he realized something was not right. “I realized the mother’s placenta was difficult to deliver, I tried to remove it but she was bleeding profusely. Finally, the placenta came out, but she continued losing blood,” he explains.

Mr. Kilosi went through all the medical protocols that are the norm to manage such cases, but the blood did not stop gushing out. He narrates: “I had put the patient on normal saline, gave her up to forty doses of syntocinon,  but she did not improve much.  I was afraid I would lose the patient.”

Although Everlyne was at times unconscious, she recounts that she could still hear the nursing officer issuing instructions. “I heard him order for a balloon. They brought it and he told me he was going to insert it in my womb and that it may stop the bleeding,” recalls Everlyne. Mr. Kilosi, with the help of other support staff, managed to place the balloon in the mother’s uterus and immediately the bleeding stopped. Everlyne lost 700 milliliters of blood. She was clinically pale and had gone into shock. If the bleeding continued they could have lost her, he explains.

“This mother is  proof that the ESM-UBT kit can save lives. It is a simple, but very effective method to control PPH,” concludes Mr. Kilosi, a first time user of the ESM-UBT kit.

To learn more view this interview with Everlyne and and Mr. Kilosi:

Provided by: KMET

Kenya Experience: ESM-UBT Kit Saves a Mother of Three

In a quiet homestead in Kosinyo village, Siaya County, Kenya, Lilian Achieng Omondi rocks her two-month old baby. Her first born, sits next to his mother as though to get a glimpse of the young one who is about to sleep. Their brother, plays outside the house. All three children are clearly oblivious of the challenges that their mother has undergone to give birth to them.

Achieng, 28, has experienced postpartum hemorrhage since giving birth to her first born son. Postpartum hemorrhage,  contributes to 287,000 deaths in Kenya, 34% of overall maternal deaths.

During her first birth, Achieng experienced minimal complications and bleeding thereafter. Five years later, she would undergo the same experience for her second birth. But this time, she remembers, the bleeding got worse. Achieng sought help at a nearby health facility, and after being injected with oxytocin, the bleeding stopped.

However, the birth of her third child was the most complicated. “I experienced heavy bleeding and the injection did not help this time. It started with very painful labor that lasted about five hours.” Achieng took herself to a health facility at 06:00 and delivered at 12:30. “I saw my baby, breastfed her, and immediately I became unconscious,” she recalls.

Achieng was rushed to another health center – Akala Health Centre in Siaya County – where she regained consciousness.

“When I woke up, I noticed something strange in my body. The doctor was removing some water from my body using a syringe. It was not painful. At this time, I had gained consciences and the bleeding had stopped,” she explains. It was the ESM-Uterine Balloon Tamponade (UBT) kit that was used to stop Achieng’s excessive bleeding.

The ESM-UBT kit is locally assembled by the Kisumu Medical and Education Trust (KMET). It consists of a pair of condoms, a rubber catheter, a string, two data cards, a referral card and a 60ml syringe. KMET provides heath facilities with the ESM-UBT kits, a three hours simulation based training, pocket checklists, delivery room wall charts, and reference manuals. Field data highlights the high success rate of the ESM-UBT: persistent bleeding after birth can be successfully controlled in 98% of cases.

After KMET introduced the ESM-UBT kit to the Akala Health Center,  Chris Opati, the Clinical Officer at the center, noted the ESM-UBT kit had saved the lives of two women, including Achieng. Opati remains hopeful.

Kenya Experience: ESM-UBT Saves a Mother of Nine in Migori, Kenya

Hellen Achieng was waiting to be served breakfast at 8.00 a.m. on a Sunday morning in the post-delivery ward when she felt sudden pain in her abdomen, she looked down and her cloth was soaked in blood. A nurse had just walked in to check on her and her 9th baby, who was delivered that morning.

She told the nurse she was not feeling well but when she tried to reposition herself on the bed she felt more blood gushing out. “It was like someone had poured blood with a basin on my bed,” Hellen described the scene. “I felt dizzy and thought I was dying. I screamed as the nurse looked at me shock written all over her face” she says.

The nurse shouted for help, and the team rushed Hellen back to the delivery room where she says, they gave her an injection of oxytocin. Hellen continued to lose blood.

“I kept thinking of my new born and my other eight children-wondering how they would survive without their mother,” she recalls.

Moments before Hellen passed out, she remembers seeing two healthcare providers using something like ‘trust’ (a common condom brand in Kenya)  which they inserted in her uterus using a small pipe. The providers had used the ESM-UBT to stop the uncontrollable bleeding that Hellen was experiencing after giving birth.

“I had died thrice. I would wake up and get unconscious again, my sister in law who was at the hospital told me later,” recounts Hellen who gained consciousness at St. Camilla, a private Mission Hospital where she had been referred to for blood transfusion after the providers in Sori Health Centre successfully arrested the hemorrhage.


Colombia Experience

In Colombia, postpartum hemorrhage has been an essential problem of maternal mortality; the entity has raised public sector alarms for the development and implementation of programs that optimize its management. Cali is located in the department of Valle del Cauca; it is the reference city of the Colombian Southwest due to the high complexity of its hospitals; one of them is the Hospital Universitario Fundación Valle del Lili. In this region an Obstetric Critical Care Unit has been established as a center of care for patients with a high risk of mortality and extreme maternal morbidity. We receive patients from all regions of the country, especially from the hospitals to which we perform the intervention that will be explained later (16 hospitals)

According to the most recent statistics (2018), the department has three municipalities where maternal mortality exceeds the national maternal mortality ratio.






















Given the statistics of maternal morbidity and mortality reported in the last two decades, in 2013, the Obstetrician group composed of 24 Obstetricians decided to implement the American model of PPH treatment and began using bundles for postpartum hemorrhage as an approach to reduce complications derived from excessive bleeding. Initially, there were master classes, simulation exercises to disseminate and systematize patient care standards among the medical and nursing group. In that year, the red code included non-pneumatic anti-shock garment, uterine balloon tamponade, uterotonics, and hemostatic agents such as tranexamic acid. In  addition to the international standard, rapid response teams in obstetrics, emergency transfusion packages, adequate equipment for obstetric emergency care were established. Bundles were well received in our hospital, but despite some positive results in indicators of maternal and perinatal morbidity and mortality, the treatment of postpartum hemorrhage was carried out differently depending on the Obstetrician on a particular shift.  For this reason, in the second period corresponding to 2017 until today (2020), we created checklists which allowed all obstetricians to adopt the same standard to avoid delays and complications during a red code. Following a red code, we initiated reporting systems and post-event learning meetings (debriefing). This strategy had a positive impact on maternal and perinatal outcomes such as decrease days in-hospital stay, number of transfusions, decrease in the rate of hysterectomies, etc.

Despite the benefits of the implementation, in Colombia, we did not have enough evidence to justify the use of the bundles. Due to the socio-economic conditions of our country, it was difficult to find necessary equipment and drugs (like the NASG) for the red code in primary and secondary hospitals.  So the group of obstetricians of Fundacion Valle del Lili decided to write a paper to demonstrate the effectiveness.  We compared PPH patients from the period from 2011 to 2013 (77 patients) who received standard management without a non-pneumatic anti-shock garment (NASG) and (77 patients) 2014 to 2015 who received standard PPH management plus NASG. The results obtained were the following: the leading causes of PPH were uterine atony (96.1%), placental retention (9.7%), abruption of the placenta (6.5%), and placenta previa (4.5%). All patients in the first period showed shock rates higher than 1 which was directly related to hemodynamic instability secondary to hypovolemia, 89% of cases required massive transfusion.

The results showed that the need for blood products was statistically significant WHEN COMPARING THE 89% in the non-NASG group tO 39%and the NASG group, Abdominal hysterectomy was more common in the non-NASG group compared to the NASG group (98.2% versus 1.8%). In conclusion the use of NASG in critically ill patients demonstrated a speedy recovery from hypoperfusion, in addition to the prevention of the use of invasive procedures that produces an increase in maternal morbidity and an increase in costs.

These results allowed the Obstetrics team to make visits and to record which hospitals had all the necessary tools for the full practice of the red code. During the visits, some hospitals had the NASG, but staff did not know the technique and the right time to use it.  In other cases, they did not have the NASG because it “represented a high cost” for the hospital (230.00 US) These findings stimulated staff and administration to seek funding and develop an action plan that would improve the care of obstetric patients and diminished mortality.

So, in 2017 with the Health Secretary of the district of Valle del Cauca, the group of Obstetricians began the training and on-site simulations in 5 nearby hospitals of Primary, Secondary and Tertiary care. Additionally, it was possible to carry out multiple simulation practices in our institution with collaboration   from the remaining hospitals of Cali. Due to the positive feedback, Dr. María Fernanda Escobar initiated a Telemedicine strategy as a project leader for implementing the bundles in a red code for referring hospitals.

In August 2018, the project was extended to all the North of Cauca department, where maternal mortality far exceeded the national average.  As of Dec 31 2019 the results show a major reduction of maternal mortality in the intervention area. These results present a challenge to expand open telemedicine to other regions of Colombia. As of January 2020 the group received more than one hundred tele-consults.

Now, when comparing pre and post-intervention statistics at the national level, it is observed how maternal mortality has been declining. (Table 1 and 2). These results provide hope and motivation to continue our magnificent work of improving the quality of care of obstetric patients.??? using bundles, red code and standard check lists for PPH diagnosis and treatment…


Table 1

Maternal mortality notification

Colombia, weeks 01-50, 2015 – 2017

Year Early Late Coincident Total
2015 330 99 43 472
2016 306 124 36 468
2017 328 109 35 472


Table 2

Maternal mortality notification

Colombia, weeks 01-23, 2017 – 2019

Year Early Late Coincident Total
2017 163 63 21 247
2018 110 71 44 225
2019 145 43 22 210


On-site master seminars
Simulation scenario – necessary implements for red code attention









Simulation scenario: necessary implements for red code attention
Clinical simulation: Red code attention