Postpartum Hemorrhage; Efficacy of Balloon Tamponade in the Management

Abstract

… Primary postpartum hemorrhagic, rightly called as obstetrician's nightmare, refers to excessive blood loss of more than 500ml during the third stage of labour or in the first 24 hours after delivery. It continues to be one of the leading causes of maternal mortality and morbidity all over the world including Pakistan where it is responsible for 21-31% of maternal mortality and morbidity. Objectives: Objective of study was to determine the efficacy of balloon tamponade in the management of primary PPH, so that a low cast, easy to use technology is available for conserving future fertility by treating postpartum hemorrhage. Settings: Department of Gynae & Obs, Allied Hospital, Faisalabad. Study Design: Descriptive cross sectional study. Study Period: 6 months from 1 st Oct, 2015 to 31 st March, 2016. Material & Methods: All patients delivered vaginally at term (after 37 completed weeks of gestation) who developed PPH due to uterine atony after failure of conventional medical therapy were included in this study. Patient selection was based on inclusion and exclusion criteria. Their demographic profile and efficacy of balloon tamponade was checked in terms of time required to control hemorrahage and need of laparotomy. Results: During study period total no. Of vaginal deliveries were 3000. Out of these 298 developed PPH, 220 had PPH due to uterine atony and did not respond to conventional medical therapy. The age of patients ranged between 22 and 40 years with mean age of 30 year (±4.88SD). The parity of the patients ranged between 1 and 14 with the mean parity of 4 (±2.26SD). The condom catheter was introduced in all the selected 80 patients and was successful in 73 patients. Conclusions: In developing countries such as Pakistan where the maternal death rate from PPH is very high, this safe, in expensive and easy procedure (it does not require any expertise) can be applied in any situation to save a life and to save the uterus in young patients to conserve reproductive capacity and prevent them from surgery and its morbidity. This will protect the patients from irreversible shock and even death with a success rate of 85-95%.

Efficacy of Balloon Tamponade in Postpartum Hemorrhage

“…If these attempts fail then surgical intervention is needed including external compression with uterine sutures, ligation of uterine artery and internal iliac artery and if failed then hysterectomy as a last resort. [4][5][6][7] Intrauterine Balloon tamponade is being used in world with different methods using bakery balloon, folley's catheter and condomes. These gadgets are placed in utero and inflated with sterile fluid to produce temponade effect on uterine walls in order to stop bleeding.…”