As you begin Uterine
• Consider ABC… for PPH…
• Assess Bleeding / anesthesia
• Bladder drainage
• Check for laceration
• Dial for HELP
• Evacuate Uterus
Keep in mind possibility of Disseminated
Intravascular Coagulation (DIC) !
Balloon Tamponade in Use
$250 per device
$220 for two devices
$77 (quoted £50)
$200 per device
These commercially available devices are prohibitively expensive
Source: Georgiou C. Balloon tamponade in the management of postpartum haemorrhage: a review.
The Condom /Catheters Unit
can be assembled in a few
minutes and cost of
components is ≤ U.S.$5
The Innovative Condom Tamponade Unit
A condom still saves lives even during Childbirth!
Developed in Bangladesh
by Ashkter and Team
Inflate Condom with water
till no further bleeding is
occuring (usually about
300-500 mls )
Apply clamp to keep water within
Condom after inflation
THE CONDOM TAMPONADE
Contraindications for Balloon
• Where uterine rupture is suspected
• Disseminated Intravascular Coagulation (DIC) *.
• If hysterectomy is indicated.
Note: Maximum indwell time is 24 hours (Bakri manufacturer
Balloon may be removed sooner upon physician judgment
Balloon / condom can be deflated slowly over several hours while
Once fully deflated remove the vaginal packing and gently retract the
balloon and discard.
Continue to monitor the patient for signs of uterine bleeding.
• 13 studies
• 6 case reports, series
• 5 prospective studies
• 2 retrospective studies
• 241 women
• No randomized controlled trial
• Condom catheter N=193
• Foley N=5
• Sengstake-Blakemore N=1
• Not defined N=15
• Blood loss 550-5000 mL before balloon
• Success 234/241
• No RCT
• 22 case series, 18 case reports, 2 reviews
• Sengstaken, Foley, Bakri, Rusch, condoms
• Success rate (no hysterectomy, invasive procedures) 60-100%
… in case you remove the placenta partially and it bleeds
Power point slides made by Dr. Sylvia Degans for MCHIP – slide set can be viewed
American College of Obstetricians and Gynecologists. ACOG practice bulletin: clinical
management guidelines for obstetrician-gynecologists number 76. Obstet Gynaecol.
Bakri YN, Amri A, Abdul Jabbar F. Tamponade-balloon for obstetrical bleeding.
Int J Gynaecol Obstet. 2001;74(2):139-142.
Condous GS, Arulkumaran S, Symonds I, et al. The “tamponade test” in the management
of massive postpartum hemorrhage. Obstet Gynecol. 2003;101(4):767-772.
Dabelea V, Schultze P, McDuffie R. Intrauterine balloon tamponade in the management of
postpartum hemorrhage. Am J Perinatol. 2007;24(6):359-364.
Nelson WL, O’Brien JM. The uterine sandwich for persistent atony: combining the
B-Lynch compression suture and an intrauterine Bakri balloon. Am J Obstet Gynecol.
B-Lynch C, Keith L, Lalonde A, et al., eds. A Textbook of Postpartum Hemorrhage:
A Comprehensive Guide to Evaluation, Management and Surgical Intervention. Duncow,
Kirkmahoe, Dumfriesshire, UK: Sapiens Publishing; 2006.
Bakri YN. Balloon device for control of obstetrical bleeding. Eur J Obstet Gynecol Reprod Biol.