Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 13 , ISSUE 4 ( July-August, 2021 ) > List of Articles

Original Article

Balloon Tamponade—A Novel Innovation in the Management of Refractory Postpartum Hemorrhage at Tertiary Care Center: A Study from Central India

Rajat Sharma, Shyamkumar Shankarrao Sirsam, Prachi S Koranne, Aparna R Wahane

Keywords : Compression sutures, Refractory PPH, Rescue hysterectomy, Stepwise devascularization, UBT, Uterotonics

Citation Information : Sharma R, Sirsam SS, Koranne PS, Wahane AR. Balloon Tamponade—A Novel Innovation in the Management of Refractory Postpartum Hemorrhage at Tertiary Care Center: A Study from Central India. J South Asian Feder Obs Gynae 2021; 13 (4):221-225.

DOI: 10.5005/jp-journals-10006-1930

License: CC BY-NC 4.0

Published Online: 20-11-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in low-income countries and the primary cause of nearly one-quarter of all maternal deaths globally. Refractory PPH is defined as PPH failed to respond to the medical line of management and requiring second-line treatment in the form of balloon tamponade, compression sutures, stepwise devascularization, or hysterectomy. Aim and objective: To assess the effectiveness of balloon tamponade in the management of refractory PPH and reduction in surgical interventions with the use of uterine balloon tamponade. Materials and methods: Prospective data of all 53 women with refractory PPH who underwent balloon tamponade after failed medical management that were collected over a period of 1.5 years were analyzed. Results: The study includes women from 20 to 35 years of age. The mean age of the study population was 24.81 ± 4.468 years. The estimated amount of blood loss in this study ranges from 700 to 2000 mL, and the mean estimated amount of blood loss was 1260.38 ± 333.02 mL. The success rate of balloon tamponade alone was 84.90%, while when combined with additional surgical intervention—compression sutures and stepwise devascularization—overall success rate increased up to 98.11% in this study, while one patient underwent rescue hysterectomy despite balloon tamponade. The failure rate was 1.89%. Conclusion: UBT is novel innovation for the management of refractory PPH, and real-time blood loss assessment through Bakri balloon alerts and guides the surgeon in major decisions before proceeding to rescue hysterectomy. Our study recommends the use of balloon tamponade as a primary tool before proceeding for surgical interventions in case if uterotonics fail to manage PPH. Clinical significance: Balloon tamponade is simple, easy, and cost-effective intervention, especially in low resource setting for reducing maternal morbidity and mortality due to refractory PPH.


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  1. Van Hoover C, Freedman LP, Waldman RJ, et al. Who's got the power? Transforming health systems for women and children. J Midwifery Womens Health 2006;51(2):132. Available from: https://doi.org/10.1016/j.jmwh.2005.11.004
  2. WHO|WHO recommendations on prevention and treatment of postpartum haemorrhage and the WOMAN trial. 2017. Available from: https://www.who.int/reproductivehealth/topics/maternal_perinatal/pph-woman-trial/en/.
  3. Dutta DC. DC Dutta'S Textbook of Obstetrics. 9th ed. New Delhi: Jaypee Publishers.
  4. Widmer M, Piaggio G, Hofmeyr G, et al. Maternal characteristics and causes associated with refractory postpartum haemorrhage after vaginal birth: a secondary analysis of the WHO CHAMPION trial data. BJOG 2020;127(5):628–634. DOI: 10.1111/1471-0528.16040.
  5. WHO recommendations for the prevention and treatment of postpartum haemorrhage. 2012. Available from: http://apps.who.int/iris/bitstream/handle/10665/75411/9789241548502_eng.pdf; jsessionid=F644CEAFE698307A56B913FBBDB23EE9?sequence=1.
  6. Mishra N, Gulabani K, Agrawal S, et al. Efficacy and feasibility of Chhattisgarh balloon and conventional condom balloon tamponade: a 2-year prospective study. J Obstet Gynecol India 2019;69(S2): 133–141. DOI: 10.1007/s13224-018-1185-6.
  7. Kandeel M, Sanad Z, Ellakwa H, et al. Management of postpartum hemorrhage with intrauterine balloon tamponade using a condom catheter in an Egyptian setting. Int J Gynecol Obstet 2016;135(3):272–275. DOI: 10.1016/j.ijgo.2016.06.018.
  8. Santhanam R, Viswanathan RM, Priya V. Condom tamponade in the management of atonic postpartum hemorrhage. Int J Reprod Contracept Obstet Gynecol 2018;7(6):2276. DOI: 10.18203/2320-1770.ijrcog20182335.
  9. Vitthala S, Tsoumpou I, Anjum ZK, et al. Use of Bakri balloon in post-partum 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.
  10. Grönvall M, Tikkanen M, Tallberg E, et al. Use of Bakri balloon tamponade in the treatment of postpartum hemorrhage: a series of 50 cases from a tertiary teaching hospital: Bakri balloon tamponade in postpartum hemorrhage. Acta Obstet Gynecol Scand 2013;92(4): 433–438. DOI: 10.1111/j.1600-0412.2012.01531.x.
  11. 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.
  12. 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.
  13. PATH. Advancing the Ellavi uterine balloon tamponade (UBT): a low-cost UBT designed specifically for treatment of postpartum hemorrhage. 2017
  14. Bakri YN, Amri A, Abdul Jabbar F. Tamponade-balloon for obstetrical bleeding. Int J Gynecol Obstet 2001;74(2):139–142. DOI: 10.1016/s0020-7292(01)00395-2.
  15. US FDA approval ESM UBT. 2021. Available from: https://www.accessdata.fda.gov/cdrh_docs/pdf19/K191264.pdf.
  16. Keriakos R, Mukhopadhyay A. The use of the Rusch balloon for management of severe postpartum haemorrhage. J Obstet Gynaecol 2006;26(4):335–338. DOI: 10.1080/01443610600595077.
  17. Mathur M, Ng QJ, Tagore S. Use of Bakri balloon tamponade (BBT) for conservative management of postpartum haemorrhage: a tertiary referral centre case series. J Obstet Gynaecol 2018;38(1):66–70. DOI: 10.1080/01443615.2017.1328671.
  18. Fukami T, Koga H, Goto M, et al. Incidence and risk factors for postpartum hemorrhage among transvaginal deliveries at a tertiary perinatal medical facility in Japan. PLoS One 2019;14(1):e0208873. DOI: 10.1371/journal.pone.0208873. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326562/.
  19. Oberg AS, Hernandez-Diaz S, Palmsten K, et al. Patterns of recurrence of postpartum hemorrhage 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.
  20. 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.
  21. 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.
  22. Alkış İ, Karaman E, Han A, et al. The fertility sparing management of postpartum hemorrhage: 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.
  23. Cekmez Y, Ozkaya E, Öcal FD, et al. Experience with different techniques for the management of postpartum hemorrhage due to uterine atony: compression sutures, artery ligation and Bakri balloon. Ir J Med Sci 2015;184(2):399–402. DOI: 10.1007/s11845-014-1130-3.
  24. Kumru P, Demirci O, Erdogdu E, et al. The Bakri balloon for the management of postpartum hemorrhage in cases with placenta previa. Eur J Obstet Gynecol Reprod Biol 2013;167(2):167–170. DOI: 10.1016/j.ejogrb.2012.11.025.
  25. 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. Available from: https://pubmed.ncbi.nlm.nih.gov/24975399/.
  26. Vintejoux E, Ulrich D, Mousty E, et al. Success factors for Bakri™ balloon usage secondary to uterine atony: a retrospective, multicentre study. Aust N Z J Obstet Gynaecol 2015;55(6):572–577. DOI: 10.1111/ajo.12376.
  27. Cho HY, Park YW, Kim YH, et al. Efficacy of intrauterine Bakri balloon tamponade in cesarean section for placenta previa patients. PLoS One 2015;10(8):e0134282. DOI: 10.1371/journal.pone.0134282. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4532486/.
  28. 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. Available from: http://www.hkmj.org/abstracts/v19n6/484.htm.
  29. Burke T, Ahn R, Nelson B, et al. A postpartum haemorrhage package with condom uterine balloon tamponade: a prospective multi-centre case series in Kenya, Sierra Leone, Senegal, and Nepal. BJOG 2016;123(9):1532–1540. DOI: 10.1111/1471-0528.13550.
  30. Ramanathan A, Eckardt MJ, Nelson BD, et al. Safety of a condom uterine balloon tamponade (ESM-UBT) device for uncontrolled primary postpartum hemorrhage among facilities in Kenya and Sierra Leone. BMC Pregnancy Childbirth 2018;18(1):168. DOI: 10.1186/s12884-018-1808-z.
  31. Yoong W, Ridout A, Memtsa M, et al. Application of uterine compression suture in association with intrauterine balloon tamponade (‘uterine sandwich’) for postpartum hemorrhage: ‘Uterine sandwich’ for postpartum hemorrhage. Acta Obstet Gynecol Scand 2012;91(1):147–151. DOI: 10.1111/j.1600-0412.2011.01153.x.
  32. 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.
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