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.
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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