Introduction: Bimanual uterine compression may provide a reasonable treatment option for controlling or arresting postpartum hemorrhage in
areas where access to care and advancedmedical interventions are limited. Preliminary evidence suggests that correctly performed bimanual uterine
compression is unsustainable for more than a few minutes, despite empirical evidence and practice recommendations that support extended
compression for optimal effect. The objective of this study was to examine the impact of team-based (pairs) bimanual uterine compression for
managing postpartum hemorrhage from uterine atony.
Methods: Obstetricians, nurse-midwives, midwifery students, and unskilled birth attendants (N = 30) in Ghana performed bimanual uterine
compression using a simulator with objective performance feedback (6 lights) corresponding to pressure sensors on the uterus. For each participant,
we tracked the degree and duration of maintained uterine compression. Birth attendants were then paired (15 pairs) and were similarly
assessed performing the technique as a team, with 1 attendant providing external compression to the uterine fundus using 2 hands and the other
providing internal pressure against the body of the uterus with a single hand.
Results: Individuals were unable to fully compress the uterus and maintain compression for more than 150 seconds without fatiguing. All paired
teams were able to fully compress the uterus and maintain the compression for the maximum allotted time of 5 minutes.
Discussion: Results suggest that bimanual uterine compression is more effective when performed by a team, with a primary attendantmaintaining
internal lower uterine segment pressure and monitoring the patient’s condition and a partner applying external pressure to the uterine fundus.
For cases where access to advanced medical care is limited or delayed, team-applied bimanual uterine compression could enhance the ability to
control or arrest postpartum hemorrhage and increase the likelihood ofmaternal survival.
J MidwiferyWomens Health 2012;57:371–375 c 2012 by the American College of Nurse-Midwives.