Balloon Tamponade—A Novel Innovation in the Management of Refractory Postpartum Hemorrhage at Tertiary Care Center: A Study from Central India (original) (raw)
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International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: World Health Organisation recommends using Uterine Balloon Tamponade (UBT) for refractory atonic postpartum haemorrhage (PPH) management provided treatment protocols and surgical recourse is possible. Methods: This review collated literature from three electronic databases between January 2010 to December 2019 to compare clinical effectiveness, safety and use related parameters for condom-UBT, Bakri balloon and Every Second Matters (ESM) UBT devices used in India. Results: Thirty-three eligible studies reported effectiveness in managing all PPH causes ranging from 84.2% to 98.3% for condom-UBT and from 65.3% to 94.8% for Bakri-UBT. Three ESM-UBT studies reported PPH survival rates of 94% to 97.4%. Mean UBT effectiveness in controlling atonic PPH was 92.3% for condom-UBT, 84.3% for Bakri-UBT and 97.3% for ESM-UBT. Condom-UBT and Bakri-UBT were comparable across parameters whereas limited ESM-UBT evidence reported success in preventing maternal deaths. Conclusions: For li...
The Bakri tamponade balloon as an adjunct treatment for refractory postpartum hemorrhage
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2016
To evaluate the Bakri tamponade balloon as an adjunct treatment for refractory postpartum hemorrhage (PPH). A prospective observational intervention study was conducted between January 1, 2013, and May 31, 2015, at Great Lakes Hospital and Moi Teaching and Referral Hospital in Kenya. Eligible participants were diagnosed with PPH (blood loss >500mL after vaginal or >1000mL after cesarean delivery, and/or hemodynamic changes suggestive of excessive blood loss) unresponsive to standard intervention and were treated using the Bakri balloon. Case report forms were completed for all participants. The primary endpoint was the frequency of surgery after use of the Bakri balloon. Among 58 patients, postpartum bleeding was controlled without further surgical intervention in 55 (95%). Among the 55 women with uterine atony, the Bakri balloon successful controlled PPH in 52 (95%). Two of the three hysterectomies performed were for continued bleeding after placement of the Bakri tamponade b...
Intrauterine balloon tamponade for the control of postpartum haemorrhage
JPMA. The Journal of the Pakistan Medical Association, 2016
To evaluate the effectiveness of balloon temponade in the management of postpartum haemorrhage. The study was conducted at the Dow University of Health Sciences and Civil Hospital Karachi from January to July 18, 2012, and comprised women aged 18-35 years, parity 1-6 and gestational age 31-41 weeks, who developed or were admitted with primary postpartum haemorrhage due to uterine atony in whom medical treatment had failed. SPSS 10 was used to analyse the data. The mean age, parity, gestational age of 139 women was 26.4±4.2 years, 3.4±1.3, 37.81±1.67 respectively. Mean estimated blood loss was 1155.8±350.6 ml, mean systolic blood pressure 90.96±18.1 mmHg, diastolic blood pressure 55±7.5 mmHg and mean pulse was 108.3±10.89 bpm. Balloon tamponade was effective in 126(90.4%) cases. Condom catheter balloon tamponade was an effective means of controlling postpartum haemorrhage. There should be a low threshold for use of balloon tamponade as it is effective, easy to use, easily available, ...
International Journal of Nursing and Midwifery
Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and mortality worldwide. Although declining globally, maternal mortality is on the rise in the United States. Since uterine balloon tamponade (UBT) has been shown to be safe as well as highly effective in arresting PPH and halting shock progression, this study sought to clarify the practice and perceptions of UBT use among midwives and family physicians in the United States. A cross-sectional 12-item survey on the practice, experiences and perceptions of uterine balloon tamponade utilization for PPH management was conducted among midwives and family physicians that perform deliveries in the United States. The survey settings were one family medicine and two midwifery national conferences in the United States. One hundred and ninety-seven midwives (164; 83.2%) and family physicians (33; 16.8%) completed the surveys. The 197 providers had previously cared for a mean of 6.0 (SD= 18.8) uncontrolled PPH cases each, over the course of their career till date. Eighty (40.6%) of the 197 respondents had been involved with at least one hemorrhaging woman in which a UBT was placed, but only 13 (7.9%) of the 164 midwives and 6 (18.2%) of the 33 family physicians had ever placed a UBT device themselves. One hundred and thirty-one (73.6%) of 178 providers desired training on use of UBT. Midwives and family physicians in the United States care for women with uncontrolled PPH, however, infrequently place a UBT device. Most midwives and family physicians would like training on uterine balloon tamponade.
Uterine Balloon Tamponade: An Effective Tool for Managing Postpartum Haemorrhage
International journal of public health, pharmacy and pharmacology, 2024
This article explores the crucial subject of Uterine Balloon Tamponade (UBT) as a very efficient method for controlling postpartum haemorrhage (PPH). Maternal mortality continues to be a pressing issue in global health, with postpartum haemorrhage playing a prominent role in this troubling pattern. This study investigates the versatile operational processes of UBT devices, with a particular focus on their capacity to stimulate uterine receptors, initiate contractions, and exert hydrostatic pressure to halt bleeding sinuses. The research highlights the crucial importance of healthcare workers, namely nurses, in promptly identifying and skillfully implementing UBT to achieve hemostasis. This resource offers a comprehensive examination of the many factors that contribute to postpartum haemorrhage (PPH), including uterine atony and retained placental fragments. It emphasises the need of implementing focused therapies to address these causes. The article highlights the worldwide inequalities in maternal healthcare and proposes comprehensive measures to tackle shortcomings in healthcare facilities, improve accessibility, and invest in highly qualified healthcare professionals. Evidence-based procedures, including UBT, are promoted for wider
Healthcare, 2021
Background: Postpartum haemorrhage (PPH) is an unpredictable obstetric emergency that requires a multidisciplinary approach. Bakri balloon tamponade (BBT) is recommended when PPH does not respond to medical treatment. Nowadays few published studies have performed a multivariate analysis to determine the variables independently associated with BBT failure. Methods: Our study purpose was to determine the variables independently associated with BBT failure: first, in a large single-centre cohort study between 2010 and 2020, and second, in a systematic literature review using Medline and the Cochrane Library. Maternal and perinatal variables, PPH characteristics, technique-related variables and complications were recorded in the case series study, comparing between successful and failed BBT patients. Study characteristic and variables significantly associated with BBT failure were recorded in the systematic review. All studies used a logistic regression test. Results: The case series in...
South African Family Practice
Uterine balloon tamponade (UBT) should be attempted once emergency measures have been applied and medical treatment for post-partum haemorrhage (PPH) resulting from an atonic uterus has failed. Sinapi Biomedical (Pty) Ltd developed the Ellavi UBT, a free-flow pressure-controlled UBT unit. The device is affordable for use in lesser-resourced countries. A case series of Ellavi UBT used by medical officers in a rural regional hospital without specialist supervision was conducted. This case series was conducted in St Elizabeth’s Hospital in Lusikisiki, South Africa. The hospital serves as the regional hospital for the Ingquza Hill Subdistrict in the Eastern Cape Province. The Nelson Mandela Academic Hospital (NMAH) in Mthatha is the tertiary referral hospital. Workshops were conducted on the use of Ellavi UBT, and devices were made freely available to the hospital. The case series included 10 patients. Six patients delivered by caesarean section, and four had normal vertex deliveries. A...
2020
Objectives: to describe available uterine tamponade devices for the management of postpartum haemorrhage, and to evaluate its effectiveness as a treatment of refractory PPH. Search strategy: Databases searched included PubMed, EMBASE, CINAHL, LILACS and POPLINE. Study selection: To describe uterine tamponade devices any type of study was included; only randomised and non-randomised comparative studies were included to assess the effectiveness of uterine tamponade devices. Outcomes: The primary outcomes were: a composite outcome including surgical interventions or maternal death, and hysterectomy. Results: Twenty-four types of tamponade devices were identified. The Bakri and the condom-catheter balloon were the most frequently reported. One randomised controlled trial suggests non-significant increases in the composite outcome (RR 2.33, 95%CI 0.76-7.14) and hysterectomy (RR 4.14, 95%CI 0.48-35.93) associated with the condom-catheter balloon vs. no device. Another RCT suggests a non-significant reduction in the composite outcomes (RR 0.60; 95%CI 0.16-2.31) and hysterectomy (RR=0.5; 95%CI 0.05-5.25) with the Bakri balloon vs the condom-catheter balloon. A stepped-wedge study suggests an increase in the composite outcome (RR 4.08, 95%CI 1.07-15.58), and a non-significant increase in hysterectomies (RR 4.38, 95% CI 0.47-41.09) associated with the introduction of condom-catheter or surgical glove balloon into clinical settings. Conversely, non-randomised studies showed a non-statistically significant reduction (RR=0.61, 95%CI 0.27-1.40) in the composite outcome and no effect on hysterectomy associated with the use of the Bakri balloon. Conclusions: The effect of UBT for the management of atonic refractory PPH after vaginal delivery is unclear, as is the role of the type of device and the setting.
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2018
Maternal death is the greatest health disparity globally, with postpartum hemorrhage the most common cause. As senior leaders in obstetrics and maternal health from Bolivia, Canada, Colombia, Côte d'Ivoire, Honduras, India, Kenya, Nepal, Niger, Norway, Peru, Tanzania, the UK, the USA, and Zambia, we are deeply disturbed by recent calls for randomized controlled trials (RCTs) of uterine balloon tamponade (UBT) in women with uncontrolled postpartum hemorrhage (PPH). Our collective experience, in combination with mounting evidence, unequivocally supports the effectiveness of commercial and condom UBTs in averting death and disability from PPH associated with atonic uterus. We believe it would be highly unethical to embark on an RCT of UBT, now or in the future, unless compared with a proven equivalent intervention. This article is protected by copyright. All rights reserved.
Journal of Obstetrics and Gynaecology Research, 2012
To study the efficacy and complications of uterine tamponade using condom catheter balloon in nontraumatic postpartum hemorrhage (PPH). Material and Methods: This prospective study was conducted in a tertiary care teaching hospital in India. Eighteen patients with non-traumatic PPH not responding to medical management were included in the study. Uterine tamponade was achieved by a condom catheter balloon filled with saline and kept in situ for 8-48 h. The main outcome measures were success rate in controlling hemorrhage, time required to stop bleeding, subsequent morbidity and technical difficulties. Data was analyzed using appropriate statistical methods. Results: The success rate of condom catheter balloon in controlling hemorrhage was 94%. The mean amount of fluid filled in the condom catheter balloon was 409 mL. The average time taken to control bleeding was 6.2 min. The mean duration for which condom catheter balloon was left in situ was 27.5 h. The average amount of blood loss was 1330 mL. Five patients (28%) had infective morbidity. Conclusion: Condom catheter balloon is effective in controlling non-traumatic PPH in 94% cases. It is effective, simple to use, easily available and is a cheap modality to manage non-traumatic postpartum hemorrhage, especially in limited resource settings.