This document discusses various techniques for uterine balloon tamponade to control postpartum hemorrhage. It describes the historical use of uterine tamponade, proposed mechanisms of action, and various tools that can be used including the Bakri balloon, condom, Foley catheter, and B-Lynch suture. Commonly used tamponade techniques like the Bakri balloon are prohibitively expensive in many settings. The document then reviews studies on balloon tamponade, noting a 97% success rate in stopping bleeding across 241 cases without randomized controlled trials. It emphasizes the importance of vaginal packing after balloon insertion and provides guidelines for balloon removal.

1. Uterine balloon
tamponade
Mahantesh Karoshi
London, UK

2. Historical perspectives

3. Eur J Obstet Gynecol Repr Biol 1999;86:S84

4. Report of 5 cases
2001

5. From Giorgiou

7. Proposed mechanisms

9. Uterine tamponade
9

14. 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!!!

15. Balloon Migration

16. Utilized …
• Post Vaginal Delivery
• Post Cesarean Section
• Post B-Lynch

17. ”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

18. Uterine Tamponade Tools…
• Manual compression
• Laparotomy sponges/gauzes
• Bakri Balloon (by Cook Medical)
• Condom
• Sengsaken Blakemore tube
• Foley catheter for bladder
• B-Lynch

19. As you begin Uterine
Tamponade
• Consider ABC… for PPH…
• Assess Bleeding / anesthesia
• Bladder drainage
• Check for laceration
• Dial for HELP
• Evacuate Uterus

20. NOTE …
Keep in mind possibility of Disseminated
Intravascular Coagulation (DIC) !

21. 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

22. 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

23. 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

24. Contraindications for Balloon
Tamponade
• Where uterine rupture is suspected
• Disseminated Intravascular Coagulation (DIC) *.
• If hysterectomy is indicated.

25. 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:

26. • 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%

27. 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%

28. Sandwich method
… in case you remove the placenta partially and it bleeds

29. Uterine sandwich technique
29

30. 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

31. Q & A

32. Muchas Gracias