Journal of South Asian Federation of Obstetrics and Gynaecology

Register      Login

VOLUME 14 , ISSUE 5 ( September-October, 2022 ) > List of Articles

Original Article

Condom-based Uterine Balloon Tamponade: An Innovation in the Management of Postpartum Hemorrhage

Sharvari Madhukar Lothe

Keywords : Balloon tamponade, Postpartum hemorrhage, Stepwise devascularization

Citation Information : Lothe SM. Condom-based Uterine Balloon Tamponade: An Innovation in the Management of Postpartum Hemorrhage. J South Asian Feder Obs Gynae 2022; 14 (5):557-562.

DOI: 10.5005/jp-journals-10006-2138

License: CC BY-NC 4.0

Published Online: 16-11-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Background: Postpartum hemorrhage (PPH) remains the most common form of major obstetric hemorrhage and is also the leading cause of maternal morbidity as well as mortality. With the use of effective modalities and interventions to prevent and treat PPH, we can definitely reduce the burden of this life-threatening condition. In cases of PPH not responding to the medical line of management, second-line interventions like balloon tamponade, devascularization, compression sutures, and hysterectomy as the final resort can be thought of. Aims and objectives: The aim of this study is to determine the effectiveness of ESM-uterine balloon tamponade (UBT) in cases of PPH not responding to the medical line of management. Materials and methods: In this prospective case–control study, 26 cases with PPH refractory to the medical line of management in whom UBT was placed were studied. Data were collected over a period of 1 year and analyzed. Result: The total number of deliveries including vaginal as well as the cesarean section was 1,359 out of which 26 patients had PPH not responding to the medical line of management, thus contributing 1.9% incidence of refractory PPH in this study. The mean age of the study population was 28.4 ± 2.3 years, and the blood loss ranged from 800 to 3000 mL. The success rate of ESM-UBT alone was 85%, and if combined with additional interventions like stepwise devascularization and compression sutures, it increased to 96.15%. One patient required a peripartum hysterectomy in spite of all measures, so the failure rate was 3.85%. No maternal death was recorded in this study. Conclusion: ESM-UBT is an innovative approach in the management of the PPH not responding to medical management. Our study recommends using ESM-UBT in cases of PPH with failed medical management before directly proceeding with surgical interventions. Clinical significance: ESM-UBT is an inexpensive, cost-effective, easy-to-use, easily available, affordable, and effective tool to manage PPH not responding to medical management, and thus will definitely help to reduce related maternal mortality and morbidity.


HTML PDF Share
  1. Suarez S, Conde-Agudelo A, Borovac-Pinheiro A, et al. Uterine balloon tamponade for cite the treatment of PPH: a systematic review and meta-analysis. Am J Obstet Gynecol 2020; 222:293.e1–52. DOI: 10.1016/j.ajog.2019.11.1287.
  2. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392(10159):1789–1858. DOI: 10.1016/S0140-6736(18)32279-7.
  3. World Health Organization (WHO) recommendations for the prevention and treatment of postpartum haemorrhage. Geneva: WHO, 2012. PMID: 23586122.
  4. Jain R. Uterine tamponade using condom catheter balloon in the management of nontraumatic PPH. Int J Reprod Contracept Obstet Gynecol 2018;7:2617–2622. DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20182413.
  5. Mathai M, Gülmezoglu AM, Hill S. Saving women's lives: evidence-based recommendation for the prevention of postpartum haemorrhage. Bull World Health Org 2007;85:322–323. PMID: 17546315.
  6. Vitthala S, Tsoumpou I, Anjum ZK, et al. Use of Bakri balloon in postpartum haemorrhage: a series of 15 cases. Aust N Z J Obstet Gynaecol 2009;49(2):191–194. DOI: 10.1111/j.1479-828X.2009.00968.x.
  7. Grönvall M, Tikkanen M, Tallberg E, et al. Use of Bakri balloon tamponade in the treatment of PPH: a series of 50 cases from a tertiary teaching hospital: Bakri balloon tamponade in PPH. Acta Obstet Gynecol Scand 2013;92(4): 433–438. DOI: 10.1111/j.1600-0412.2012.01531.x.
  8. FIGO safe Motherhood and Newborn Health Committee, “FIGO guidelines: Prevention and treatment of postpartum haemorrhage in low resource settings”. Int J Gynecol Obst 2012;117:108–118. DOI: 10.1016/j.ijgo.2012.03.001.
  9. World Health Organization recommendation on uterine balloon tamponade for the treatment of postpartum haemorrhage. Geneva: WHO, 2021. Licence: CC BY-NC-SA 3.0 IGO.
  10. Guidance_Note_on_Prevention_&_Management_of_Postpartum_Haemorrhage.pdf. 2021. Available from: http://nhm.gov.in/images/pdf/programmes/maternal-health/guidelines/Guidance_Note_on_Prevention_&_Management_of_Postpartum_Haemorrhage. pdf.
  11. HTA_of_Uterine_Balloon_Tamponade_for_Management_of_Postpartum_Haemorrhage- Call_For_Comments.pdf. 2021. Available from https://htain.icmr.org.in/images/pdf/HTA_of_Uterine_Balloon_Tamponade_for_Management_of_Postpartum_Haemorrhage-Call_For_Comments.pdf. Accepted on: December 2019.
  12. Ford JB, Patterson JA, Seeho SKM, et al. Trends and outcomes of postpartum haemorrhage, 2003–2011. BMC Pregnancy Childbirth 2015;15:334. DOI: https://doi.org/10.1186/s12884-015-0788-5.
  13. Oberg AS, Hernandez-Diaz S, Palmsten K, et al. Patterns of recurrence of PPH in a large, population-based cohort. Am J Obstet Gynecol 2014;210(3):229.e1–229.e8. DOI: 10.1016/j.ajog. 2013.10.872.
  14. Eller AG, Bennett MA, Sharshiner M, et al. Maternal morbidity in cases of placenta accreta managed by a multidisciplinary care team compared with standard obstetric care. Obstet Gynecol 2011;117 (2 Part 1):331–337. DOI: 10.1097/AOG.0b013e3182051db2.
  15. Wright JD, Herzog TJ, Shah M, et al. Regionalization of care for obstetric hemorrhage and its effect on maternal mortality. Obstet Gynecol 2010;115(6):1194–1200. DOI: 10.1097/AOG.0b013e3181df94e8.
  16. Georgiou C. A review of current practice in using balloon tamponade technology in the management of postpartum haemorrhage. Hypertens Res Pregnancy 2014;2:1–10. DOI: https://doi.org/10.14390/jsshp.2.1.
  17. Alkış İ, Karaman E, Han A, et al. The fertility sparing management of PPH: a series of 47 cases of Bakri balloon tamponade. Taiwan J Obstet Gynecol 2015;54(3):232–235. DOI: 10.1016/j.tjog.2014.03.009.
  18. Kong MC, To WW. Balloon tamponade for postpartum haemorrhage: case series and literature review. Hong Kong Med J 2013;19(6): 484–490. DOI: 10.12809/hkmj133873.
  19. Alouini S, Bedouet L, Ramos A, et al. Bakri balloon tamponade for severe post-partum haemorrhage: efficiency and fertility outcomes. J Gynecol Obstet Biol Reprod (Paris) 2015;44(2):171–175. DOI: 10.1016/j. jgyn.2014.05.010.
  20. Sharma R, Sirsam SS, Koranne PS, et al. Balloon tamponade—A novel innovation in the management of refractory PPH at tertiary care center: A study from Central India. J South Asian Feder Obst Gynae 2021;13(4):221–225. DOI: https://doi.org/10.5005/jp-journals-10006-1930.
  21. Nelson WL, O'Brien JM. The uterine sandwich for persistent uterine atony: combining the B-Lynch compression suture and an intrauterine Bakri balloon. Am J Obstet Gynecol 2007;196(5):e9–e10. DOI: 10.1016/j.ajog.2006.10.887.
  22. Garg R, Agarwal V, Singh S, et al. Role of condom catheter in managing PPH in developing country, India. Indian Obst Gynecol 2018;8:8–10.
  23. Garg R, Yadav A. Condom balloon tamponade for PPH in developing countries: Cost-effective boon for saving mothers. J South Asian Feder Obs Gynae 2022;14(2):189–191.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.