Uterine Balloon Tamponade in Combination with Topical Administration of Tranexamic Acid for Management of Postpartum Hemorrhage

Abstract

While uterine balloon tamponade is an effective modality for control of postpartum hemorrhage, the reported success rates have ranged from the level of 60% to the level of 80%. In unsuccessful cases, more invasive interventions are needed, including hysterectomy as a last resort. We developed a modified tamponade method and applied it to two cases of refractory postpartum hemorrhage after vaginal delivery. The first case was accompanied by uterine myoma and low-lying placenta. After an induced delivery, the patient had excessive hemorrhage due to uterine atony. Despite oxytocin infusion and bimanual uterine compression, the total blood loss was estimated at 2,800 mL or more. The second case was diagnosed as placental abruption complicated by fetal death and severe disseminated intravascular coagulation, subsequently. A profuse hemorrhage continued despite administration of uterotonics, fluid, and blood transfusion. The total blood loss was more than 5,000 mL. In each case, an intrauterine balloon catheter was wrapped in gauze impregnated with tranexamic acid, inserted into the uterus, and inflated sufficiently with sterile water. In this way, mechanical compression by a balloon and a topical antifibrinolytic agent were combined together. This method brought complete hemostasis and no further treatments were needed. Both the women left hospital in stable condition.

Second generation of intrauterine balloon tamponade: new perspective

“…The clear silicone or polyvinyl chloride (PVC) shaft, allows for better visualisation of flow and helps in care and maintenance. Separate medication port for intrauterine topical treatments, for example, uterotonics, antibiotics, tranexamic acid as the efficiency of these treatment were reported in other studies 18–20. Radiopaque stripe for X-ray placement verification.…”

Topical use of tranexamic acid for the management of post-procedural rectal bleeding

“…Topically, it is extensively used in orthopedic surgery and has been shown to decrease peri-operative bleeding in cases of total hip/knee arthroplasty [2][3][4]. It use is also reported in dental/ oral bleeding [5], and post-partum hemorrhage [6]. In the ED, topical TXA has primarily been used for cases of epistaxis [7].…”

The effectiveness of using uterine tampons in treating uterine atony

“…Balki et al (2021) stated that the success rate using this method reached ˃95%. Another method reported in a study conducted by Kinugasa et al (2015) was an intrauterine balloon catheter covered with gauze impregnated with tranexamic acid. There were two cases of refractory PPH with bleeding of approximately 2,800 mL and 5,000 mL who had been given uterotonics reported in the study.…”

“…This method is a combination of mechanical compression and the use of topical antifibrinolytic agents, which results in complete hemostasis without the need for additional therapy. Further research is needed to determine the effectiveness and safety of this method (Kinugasa et al, 2015).…”