Condom Tamponade in the Management of Primary Postpartum Haemorrhage: A Report of three cases in Ghana (original) (raw)
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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, ...
The New Indian Journal of OBGYN
Objectives: To compare the efficacy and safety of JH balloon tamponade and Foley's condom balloon tamponade (FC) to control atonic postpartum haemorrhage. Methods: The prospective randomized control trial was conducted on 100 patients of atonic PPH who were randomly assigned into two groups: Group 1 (50 cases): managed by Foley's condom balloon and Group 2 (50 cases): managed by JH balloon tamponade. The outcome measures were time of insertion of the UBT and time of stoppage of bleeding. Any side effects or slippage of the balloon was also noted. The patients were followed up at 6 months to determine the long term outcomes in terms of menses, uterine cavity and pregnancies. Results: Success rate was 92% in cases of JH balloon tamponade while it was 88% in cases of FC balloon tamponade respectively (p-0.74). In 6 cases of failure in FC group, 2 each were managed with B-Lynch sutures, uterine artery ligation and sub-total hysterectomy while the 4 cases of failure in JH group were managed by B-Lynch sutures and uterine artery ligation (p=0.418). Mean time to making, insertion and inflation of the catheter (3.01 vs 3.12 mins; p-0.09) and mean time to stop bleeding was comparable between the FC and JH groups (7.08 vs 6.91 mins; p-0.65). In FC group 10 patient out of 50 slippage of balloon tamponade occurred whereas only 1 patient in JH group slippage of JH balloon tamponade occurred (p=0.008). At 6 months follow up, 38 patients in FC group and 40 patients in JH group reported no adverse long term outcomes. They had normal menstrual cycles with no subsequent pain during that period. Conclusion: In conclusion, success rate of Foley's condom balloon and JH balloon tamponade was good and comparable (88% and 92% respectively). Both balloon tamponade utilizes the existing resources to their best and can be easily made even in resource poor peripheral health center without wastage of time. So both type of balloon can be successfully used in atonic PPH protocols before opting for surgical options.
Use of an Innovative Condom Balloon Tamponade in Postpartum Haemorrhage: A Report
The Journal of Obstetrics and Gynecology of India, 2015
In order to meet the Millennium Development Goals [1], we must achieve a reduction in the deaths due to postpartum haemorrhage (PPH) which is the major contributor in the developing countries [2]. As per WHO recommendations, the use of intrauterine balloon tamponade (UBT) is recommended for the treatment of PPH due to uterine atony if women do not respond to uterotonics [3]. FIGO also included uterine balloon tamponade as a recommended second-line intervention for the treatment of PPH [4]. The successful outcome of balloon tamponade is reported to be 80–100 % [5]. This high efficacy avoids surgery which is often delayed or may be unavailable thereby costing the women her life. Intrauterine balloon may also be used as a temporizing measure while awaiting transfer or to resuscitate her. The commercially available uterine-specific devices are designed with an intrauterine drainage port but have a prohibitively high cost. Low resource settings have to rely on lower cost adaptations like...
Case Reports in Clinical Medicine, 2021
Background: Postpartum haemorrhage is the leading cause of maternal deaths worldwide, the majority of which occur in low resource settings. Uterine atony is the commonest cause of postpartum haemorrhage. Uterine balloon tamponade (UBT) is an effective method of treating refractory postpartum haemorrhage. Aim: Commercial UBT devices are often not affordable and not readily available in rural settings. The aim of this paper is to report on three cases of postpartum haemorrhage successfully managed with uterine balloon tamponade using Foley catheters. Case Reports: We report on three patients with major obstetric haemorrhage from uterine atony who were successfully managed with uterine balloon tamponade using Foley’s urethral catheter. The first two patients had primary postpartum haemorrhage while the third patient had significant bleeding during the surgical evacuation of the uterus for a molar pregnancy. In each case, uterine bleeding was refractory to pharmacologic uterotonics. The...
BMC pregnancy and childbirth, 2018
Postpartum hemorrhage is the leading cause of maternal mortality in low- and middle-income countries. While evidence on uterine balloon tamponade efficacy for severe hemorrhage is encouraging, little is known about safety of this intervention. The objective of this study was to evaluate the safety of an ultra-low-cost uterine balloon tamponade package (named ESM-UBT) for facility-based management of uncontrolled postpartum hemorrhage (PPH) in Kenya and Sierra Leone. Data were collected on complications/adverse events in all women who had an ESM-UBT device placed among 92 facilities in Sierra Leone and Kenya, between September 2012 and December 2015, as part of a multi-country study. Three expert maternal health investigator physicians analyzed each complication/adverse event and developed consensus on whether there was a potential causal relationship associated with use of the ESM-UBT device. Adverse events/complications specifically investigated included death, hysterectomy, uterin...
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...
BJOG: An International Journal of Obstetrics & Gynaecology, 2019
ObjectiveTo assess the effectiveness of introducing condom‐catheter uterine balloon tamponade (UBT) for postpartum haemorrhage (PPH) management in low‐ and middle‐income settings.DesignStepped wedge, cluster‐randomised trial.SettingEighteen secondary‐level hospitals in Uganda, Egypt and Senegal.PopulationWomen with vaginal delivery from October 2016 to March 2018.MethodsUse of condom‐catheter UBT for PPH management was introduced using a half‐day training and provision of pre‐packaged UBT kits. Hospitals were randomised to when UBT was introduced. The incident rate (IR) of study outcomes was compared in the control (i.e. before UBT) and intervention (i.e. after UBT) periods. Mixed effects regression models accounted for clustering (random effect) and time period (fixed effect).Main outcome measuresCombined IR of PPH‐related invasive surgery and/or maternal death.ResultsThere were 28 183 and 31 928 deliveries in the control and intervention periods, respectively. UBT was used for 9/1...
Intra uterine condom balloon tamponade-a life saving measure in atonic pph
International Journal of Recent Scientific Research
Objective-To assess the effectiveness of intrauterine condom balloon tamponade in achieving haemostasis, in cases of atonic post partum haemorrhage. Design-Prospective observational study Setting-Emergency labour room of Obstetrics and Gynaecology Department of a tertiary care hospital & teaching institution Study period-January 2013-December 2015 Material & methods-Thirty women having atonic PPH in whom active management of third stage of labour and uterotonics were not effective, were selected for this study. With full aseptic and antiseptic precautions a condom was tied on a nasogastric tube and was inserted into the uterine cavity, the distal end of the tube was connected to an IV set through which 250-500cc normal saline was instilled to inflate the condom so as to achieve haemostasis. Observation-46.6% women were between 25-30 yrs of age, 53.3% were multigravida. The gestational age was between 37-40 weeks in 80% cases. In 53.3% cases, there was some associated risk factor for PPH. In 72.72% cases placenta took alonger time to separate. In 66.6% women 250-500ml saline was instilled to inflate the condom balloon. It took 10-15 minutes time from insertion of the condom balloon catheter to achieve haemostsis in 73.3% women. The condom balloon catheter was kept in situ for 12-24 hrs in 73% women. Success rate of balloon tamponade was 90%. There was no infection in any case. Conclusion-Intrauterine condom balloon tamponade is effective, cheap and requires little skill. It can be used as a second line intervention in the management of atonic PPH. Skilled birth attendants in remote areas can use this technique and then transfer the woman to tertiary care unit. This will help in saving many maternal lives.
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.
Aims:This study evaluates the effectiveness of condom tamponade in the management of massive obstetric hemorrhage. Methods: This hospital based prospective descriptive study was done in the department of obstetrics and gynecology of KIST Medical College Teaching Hospital, Lalitpur, Nepal from January 2013 to December 2013. During the study period, patients with obstetric hemorrhage(>500ml blood loss) were identified and the details of the patient and their treatment were acquired. Data analysis was done by descriptive statistics using mean, median and frequency cross tabulations. The decision for condom tamponade was made when active continuous hemorrhage persisted despite of initial conservative measures. Results: Among 39 patients of obstetric hemorrhage out of 1522 deliveries, eight were managed by condom tamponade which includes 6 postpartum hemorrhage cases, 1 incomplete abortion case and 1 antepartum case managed prophylactically in anticipation of postpartum hemorrhage. Conclusions: Despite of the small study sample, the study concludes the use of condom tamponade as an effective means of controlling massive obstetrical hemorrhage due to uterine atony (both in post partum and post abortion cases). It is safe, easily available, inexpensive, minimally invasive, does not require anesthesia, easy to use and can be performed by any level of health personnel with some training.