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Uterine balloon tamponade in Postpartum Hemorrhage (PPH)

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Postpartum Hemorrhage, PPH, Role of uterine balloon tamponade

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Uterine balloon tamponade in Postpartum Hemorrhage (PPH)

  1. 1. Uterine balloon tamponade Mahantesh Karoshi London, UK
  2. 2. Historical perspectives
  3. 3. Eur J Obstet Gynecol Repr Biol 1999;86:S84
  4. 4. Report of 5 cases 2001
  5. 5. From Giorgiou
  6. 6. Proposed mechanisms
  7. 7. Uterine tamponade 9
  8. 8. No matter what you use to Tamponade the uterus … • Very Very Very Important to ALWAYS pack the vaginaafter insertion of balloon or any uterine packing!!!
  9. 9. Balloon Migration
  10. 10. Utilized … • Post Vaginal Delivery • Post Cesarean Section • Post B-Lynch
  11. 11. ”Tamponade test” Tamizian & Arulkumaran, Clinical Obstetrics & Gynaecology 2002;16(1);81-98. • To select cases for laparotomy • Intrauterine balloon, 75-150++ mL warm NaCl until balloong visible in cervix  minor bleeding  Balloon + pack vagina to keep balloon in place + oxytocin i 12-24 h + broad spectrum antibiotics  next day: deflate balloon – bleeding?  30 min: stop oxytocin  30 min: remove balloon
  12. 12. Uterine Tamponade Tools… • Manual compression • Laparotomy sponges/gauzes • Bakri Balloon (by Cook Medical) • Condom • Sengsaken Blakemore tube • Foley catheter for bladder • B-Lynch
  13. 13. As you begin Uterine Tamponade • Consider ABC… for PPH… • Assess Bleeding / anesthesia • Bladder drainage • Check for laceration • Dial for HELP • Evacuate Uterus
  14. 14. NOTE … Keep in mind possibility of Disseminated Intravascular Coagulation (DIC) !
  15. 15. Commercially Available Balloon Tamponade in Use Bakri $250 per device Sengstaken–Blakemore $220 for two devices Rusch hydrostatic $77 (quoted £50) BT-CATH $200 per device These commercially available devices are prohibitively expensive Source: Georgiou C. Balloon tamponade in the management of postpartum haemorrhage: a review. BJOG 2009;116:748-757
  16. 16. 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
  17. 17. Inflate Condom with water till no further bleeding is occuring (usually about 300-500 mls ) UTERUS Foleys Catheter Condom String Apply clamp to keep water within Condom after inflation Giving set Water/NS OR syringe THE CONDOM TAMPONADE Clean water
  18. 18. Contraindications for Balloon Tamponade • Where uterine rupture is suspected • Disseminated Intravascular Coagulation (DIC) *. • If hysterectomy is indicated.
  19. 19. Note: Maximum indwell time is 24 hours (Bakri manufacturer Guidelines) Balloon may be removed sooner upon physician judgment Balloon / condom can be deflated slowly over several hours while monitoring bleeding Once fully deflated remove the vaginal packing and gently retract the balloon and discard. Continue to monitor the patient for signs of uterine bleeding. Balloon Removal:
  20. 20. • 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 97%
  21. 21. WHO 2012 • No RCT • 22 case series, 18 case reports, 2 reviews • N=278 • Sengstaken, Foley, Bakri, Rusch, condoms • Success rate (no hysterectomy, invasive procedures) 60-100%
  22. 22. Sandwich method … in case you remove the placenta partially and it bleeds
  23. 23. Uterine sandwich technique 29
  24. 24. Power point slides made by Dr. Sylvia Degans for MCHIP – slide set can be viewed www.mchip.net/.../Updates%20on%20new%20technologies%20for%20t... American College of Obstetricians and Gynecologists. ACOG practice bulletin: clinical management guidelines for obstetrician-gynecologists number 76. Obstet Gynaecol. 2006;108(4):1039-1047. 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. 2007;196(5):e9-e10. 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. 1999;86:S84. References
  25. 25. Q & A
  26. 26. Muchas Gracias

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