Uterine prolapse (also called descensus or procidentia) means the uterus has descended from its normal position in the pelvis farther down into the vagina.Cervicopexy is fertility conserving surgical management of prolapse.
Uterine prolapse (also called descensus or procidentia) means the uterus has descended from its normal position in the pelvis farther down into the vagina.Cervicopexy is fertility conserving surgical management of prolapse.
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
Please find the power point on Management of Preterm labor. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
For difficult vaginal delivery,forceps delivery,vacuum application are done to assist the vaginal delivery.Many types of forceps are there divided in 3 categories.
Laparoscopic sterilization was the first popular minimal access surgical procedure ever performed. Laparoscopic sterilization is very straightforward procedure. Worldwide laparoscopic sterilization is now the most commonly applied method for family planning
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
Please find the power point on Management of Preterm labor. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
For difficult vaginal delivery,forceps delivery,vacuum application are done to assist the vaginal delivery.Many types of forceps are there divided in 3 categories.
Laparoscopic sterilization was the first popular minimal access surgical procedure ever performed. Laparoscopic sterilization is very straightforward procedure. Worldwide laparoscopic sterilization is now the most commonly applied method for family planning
Umbilical cord prolapse by dr alka mukherjee dr apurva mukherjee nagpur m.s. ...alka mukherjee
The umbilical cord is a flexible, tube-like structure that, during pregnancy, connects the fetus to the mother. The umbilical cord is the baby's lifeline to the mother. It transports nutrients to the baby and also carries away the baby's waste products. It is made up of three blood vessels – two arteries and one vein.
Umbilical cord prolapse is a complication that occurs prior to or during delivery of the baby. In a prolapse, the umbilical cord drops (prolapses) through the open cervix into the vagina ahead of the baby. The cord can then become trapped against the baby's body during delivery. Umbilical cord prolapse occurs in approximately one in every 300 births.
An umbilical cord prolapse presents a great danger to the fetus. During the delivery, the fetus can put stress on the cord. This can result in a loss of oxygen to the fetus, and may even result in a stillbirth.
The most common cause of an umbilical cord prolapse is a premature rupture of the membranes that contain the amniotic fluid. Other causes include:
• Premature delivery of the baby
• Delivering more than one baby per pregnancy (twins, triplets, etc.)
• Excessive amniotic fluid
• Breech delivery (the baby comes through the birth canal feet first)
• An umbilical cord that is longer than usual
Diagnosis of a prolapsed umbilical cord can be in several ways.
During delivery, the doctor will use a fetal heart monitor to measure the baby's heart rate. If the umbilical cord has prolapsed, the baby may have bradycardia (a heart rate of less than 120 beats per minute).
The doctor can also conduct a pelvic examination and may see the prolapsed cord, or palpate (feel) the cord with his or her fingers.
Postpartum hemorrhage is the leading cause of maternal mortality. Thereby its appropriate management is of great importance. Here I discuss the surgical management of Postpartum Hemorrhage which is done when medical management fails.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Baloon tamponade in management of postpartum haemorrhage
1. Balloon tamponade in the
management of
postpartum haemorrhage
Aboubakr Elnashar
Benha university Hospital, Egypt
Aboubakr Elnashar
2. Management of PPH
1. Exclusion: retained products
genital tract trauma.
2. Uterin atony:
a. Uterine massage
b. Uterotonic agents: oxytocin, ergometrine, misoprostol
and prostaglandin
3. If these unsuccessful: laparotomy.
a. Uterine artery ligation
b. Uterine compression sutures
c. Internal iliac artery ligation
d. Hysterectomy
Recently, uterine balloon tamponade has been added to
this armamentarium
Aboubakr Elnashar
3. Uterine tamponade
Packing or
Balloon
Indications
1. Uterotonics fail to cause sustained uterine
contractions& satisfactory control of hge after
vaginal delivery
2. Surgical treatment is unavailable at the current
site
3. Woman is too unstable to undergo surgery at
that time.
No prompt response: exploratory laparotomy.Aboubakr Elnashar
4. A. Uterine packing
Steps:
•4 inch gauze from one cornu to the other using a
sponge stick, packing back& forth, and ending with
extension of the gauze through the cervical os.
•Antibiotics
•Pack is left 24 h
•Fluid and blood component replacement.
Aboubakr Elnashar
7. B. Uterine Balloon tamponade
What?
inserting a rubber or silicone balloon into the uterine
cavity and inflating the balloon with normal saline.
Mechanism of action
1. Exerting in inward-to-outward pressure > systemic
arterial pressure: prevent continual bleeding.
2. Hydrostatic pressure effect of the balloon on the
uterine arteries.
Aboubakr Elnashar
8. Uses
I. Hge at other anatomical sites:
Bladder
Oesophagus
II. PPH from vaginal lacerations.
III. Gynaecological bleeding
1. First- and second-trimester termination of pregnancy
2. Cervical pregnancy
3. knife cone biopsy
4. Laser ablation of the endometrium
5. Dysfunctional uterine bleeding,
6. Multiple vaginal lacerations
7. Bleeding from a cervical stump following a post-CS
subtotal hysterectomy.
Aboubakr Elnashar
9. Types
1. Condom catheter
2. Rusch catheter
3. Balloon tamponade catheter
4. Foley catheter
5. SOS Bakri tamponade balloon
6. Sengstaken-Blakemore tube
Bakri balloon
Balloon tamponade catheter
specifically designed for control of pph’
If unavailable, or considered expensive: other balloons
Aboubakr Elnashar
10. Effectiveness:
•Balloon catheter has superseded uterine packing
•An appropriate intervention for most women
where uterine atony is the only or main cause of
PPH
•Hysterectomy was averted in 78%.
Aboubakr Elnashar
11. Distal component of tamponade balloons.
Asterisk: position of suture to attach condom to Foley catheter. Also represents
distal point of measurement of balloon shaft lengthAboubakr Elnashar
12. Proximal component of tamponade balloons.
Asterisk: proximal point of measurement of balloon shaft
b, d, e, f, i, j, k and m: insufflation portion of balloon
a, c, g and h: drainage portion of uterine cavity.
l and n do not contribute to balloon tamponade or drainage. They inflate a
balloon within the actual tamponade balloon.
No drainage of the uterine cavity when using the Rusch and condom catheter
Aboubakr Elnashar
13. 1. Condom catheters
• Sterile rubber catheter is inserted within the
condom and tied near the mouth of the
condom by a silk thread.
Aboubakr Elnashar
14. • Urinary bladder was kept empty by indwelling Foley's
catheter.
• After putting the patient in the lithotomy position, the
condom is inserted within the uterine cavity.
• Inner end of the catheter remained within the condom.
• Outer end of the catheter is connected with a saline
set and the condom is inflated with 250-500 mL of
running normal saline.
Aboubakr Elnashar
15. • Bleeding is observed, and when it is reduced
considerably, further inflation is stopped and the outer
end of the catheter is folded and tied with thread.
• Oxytocin drip for at least 6 h after the procedure.
• The uterine condom is kept tight in position by ribbon
gauze pack or another inflated condom placed in the
vagina.
• The condom catheter is kept for 24-48 h and then is
deflated gradually over (10-15 m) and removed.
• Triple antibiotic coverage (amoxicillin [500 mg/6 h] +
metronidazole [500 mg/8 h] + gentamicin [80 mg/8
hrs]) for 7 d.
Aboubakr Elnashar
17. 23 women with PPH due to uterine atony with
uncontrolled bleeding following administration of
uterotonics had the condom catheter placed.
•Bleeding stopped within 15 m, and no further
intervention or treatment
Management of PPH in women with impaired
coagulation, as after placental abruption
2 cases were successfully treated
Aboubakr Elnashar
18. 2. Rusch balloon
Rusch balloon and the condom catheter
conforming naturally to the contour of the uterus
do not allow drainage of the uterine cavity.
Insufflation capacity of 1500 ml
ease of use
low cost
The Sheffield guidelines suggest the use of the
Rusch balloon as a prophylactic method in cases
of women who are at increased risk of PPH and
when PPH would jeopardise the pre-existing
maternal condition’.
balloon was inflated with 400–500 ml of warm
saline
removed after 24 h following deflation at a rate of
20 ml/h
Aboubakr Elnashar
19. 3. Balloon tamponade catheter
Contours to uterine shape
provides drainage at the fundus
Dual lumen catheter that allows infusion of saline
to expand the balloon while providing uterine
drainage to monitor the progression of
hemostasis
Aboubakr Elnashar
20. 4. Multiple urinary Foley catheters
•inserted together with a ‘haemostatic substance’
applied to the oozing inner surface of the lower uterine
segment
•The uterine incision site was then closed, and each of
the balloons
was inflated with 35–75 cm3 of saline or water.
•Gentle traction was then applied to obtain a continuous
tamponade effect, and the vagina was packed.
•The catheters were then tied together, and an
examination glove or plastic bag was used for the
collection and measurement of blood loss: prevent blood
collection inside the uterine cavity and provide an
accurate estimation of bleeding.
Aboubakr Elnashar
22. Capacity: up to 500 ml of saline
Drainage channel: large bore
Use:
PPH resulting from a low-lying placenta/placenta praevia
Under US guidance, the balloon portion of the catheter
is inserted into the uterus, making certain that the entire
balloon is inserted past the cervical canal and internal
ostium
Aboubakr Elnashar
23. 6. Sengstaken–Blakemore tube
The volume of a postpartum uterus was considered too large for an effective tamponade to be
achieved by using a 30-ml Foley catheter balloon as used in gynaecological procedures.
Therefore, the Sengstaken–Blakemore two-balloon tube, originally designed for the management
of bleeding oesophageal varices, was used.
The distal, gastric balloon was filled with 300 ml of normal saline to control uterine atony following
vaginal delivery and manual removal of the placenta
Subsequently, the proximal oesophageal balloon of the Sengstaken–Blakemore tube was used
The greater cost of the Sengstaken–Blakemore tube in comparison to the Bakri balloon and the
premise that the uterine cavity requires a balloon capable of being insufflated to a large volume
resulted in the use of the urological Rusch balloon
In Sengstaken–Blakemore balloon, the tip is usually cut to allow a better fit between the balloon
and the uterine fundus.
In other studies, the distal gastric balloon is folded back when the oesophageal balloon is
insufflated
Users of the Sengstaken–Blakemore balloon suggest that ‘the
tubular oesophageal balloon of the tube would conform more
to the shape of the uterine cavity to achieve a haemostatic effect
compared to the stomach balloon or a Foley catheter’.
In the case of the Sengstaken–Blakemore tube when the distal tip is folded, the previously
available drainage channel is potentially eliminated, whereas cutting the distal tip creates a single
wide bore channel for drainage. Aboubakr Elnashar
24. Indications
•After pharmacological methods (oxytocin, ergometrine and
misoprostol) have proven to be ineffective for uterine atony.
•Can be used alone or in combination with other surgical
interventions, such as internal iliac artery ligation and the B-
Lynch suture.
Aboubakr Elnashar
26. Timing
•Early intervention of a balloon device:
less maternal morbidity {reduced blood loss}.
allow time for resuscitation of the women, obtaining cross-matched
blood and arrival of senior help
1. Prior to laparotomy following a vaginal delivery:
Successful:
negate the need for a laparotomy.
Unsuccessful:
no significant delay {insertion is easily achieved}.
reduce continuing bleeding prior to transfer to the operating theatre
2. At laparotomy or at CS
Close the uterus first and then insert the balloon from the vagina,
applying the tamponade test before closing the laparotomy site: allow
visualisation of the uterus following insufflation.
Aboubakr Elnashar
27. Inflation
minimal amount of uterine distension to accomplish
haemostasis
over-inflating’ the balloon:
distension of the uterus:
significant pain.
theoretical concern of uterine rupture
Aboubakr Elnashar
28. Use of a vaginal pack
Recommended for
•Condom catheters(or second inflated condom in the
vagina)
•Bakri balloon
•Sengstaken–Blakemore tube.
•PPH involving a dilated cervix {balloon is insufflated, it will
expand to fit the least resistant space the vagina).
Positive tamponade test needs to be demonstrated prior
to placement of the vaginal pack.
Otherwise, there is a danger that the pack will obscure any
continuing bleeding leading to a delayed diagnosis of
ineffective tamponade.
Aboubakr Elnashar
29. Tamponade test
Positive: control of PPH following inflation of the
balloon: laparotomy is not required
Negative: continued PPH following inflation of the
balloon: proceed to laparotomy.
Aboubakr Elnashar
30. Removal
After
In most cases: 4–6 h of tamponade should be
adequate to achieve haemostasis
Most papers have removed the balloon within 48 hours.
When:
during daytime hours, in the presence of appropriate
senior staff
Before its complete removal
the balloon could be deflated but left in place to ensure
that bleeding does not reoccur.
Rate of deflation
vary from 20 ml/hour to half the volume in the balloon at 12 hours.
Aboubakr Elnashar
31. Oxytocin infusion
No evidence that an oxytocin infusion is obligatory for all causes of
PPH.
If the syntocinon is continued for the duration of balloon placement,
this can range from 2 to 82 hours .
Prolonged:
hyponatraemia {cross-reactivity of the oxytocin with antidiuretic
hormone receptors.
Aboubakr Elnashar
32. Carbetocin, a synthetic analogue of oxytocin, with a
halflife of 4–10 times that of oxytocin is available. There
were no significant changes in sodium, potassium or
chloride values from predrug levels after a single dose of
carbetocin when measured at 6, 24 and 72 hours after
intravenous injection in nonpregnant women. Therefore,
this may be a preferred drug in the presence of a uterine
balloon for prolonged uterine contraction.
Although not specifically mentioned, another means of
increasing uterine tone is to encourage breastfeeding.
However, this may be impractical or declined by the
mother.
Aboubakr Elnashar
33. Antibiotic
•Objective:
to reduce the risk of iatrogenic infection caused by
contamination of the uterine environment by the
balloon from the vaginal environment.
•E.g: cephalosporin.
•Duration: ±
prophylactic (single dose),
continued for 24–48 hours or
recommended for the duration of balloon usage
Aboubakr Elnashar
34. Pain relief
During insertion:
Following a vaginal delivery:
No anaesthetic
analgesia (pethidine) may be used’.
After insertion:
no pain relief
Aboubakr Elnashar
35. Failures and complications
Few
•obstruction by uterine leiomyomata
• inadvertent damage to the balloon during preparation
of Sengstaken–Blakemore tube while cutting off the tip
•inability to place the balloon due to the presence of a B-
Lynch
suture
• insufficient insufflation requiring two balloons.
•air emboli if air is used as the distension medium for the
balloon.
•uterine rupture from uterine overdistension
•uterine perforation during insertion.
Aboubakr Elnashar
36. Future pregnancies
At present,
single pregnancy reported following the use of the
Rusch balloon
2 pregnancies following the use of a Bakri balloon in
combination with a B-Lynch suture.
Aboubakr Elnashar
37. Summary
•PPH is a potentially life-threatening event.
•In the majority of cases, relatively simple methods are
used to avert a disaster, although these are not always
employed.
•Uterine tamponade using intrauterine balloons is an
effective tool in the management of PPH {90% cases
were successful}
•Balloon tamponade is simple to arrange and with
minimal adverse effects: a familiar component for the
management of PPH
Aboubakr Elnashar