OJOG  Vol.3 No.1 A , February 2013
Intrauterine balloon tamponade in the management of severe postpartum hemorrhage: A case series from a busy UK district general hospital
ABSTRACT

Objective: To evaluate the effectiveness of balloon tamponade in the management of postpartum hemorrhage (PPH). Methods: Retrospective review of 58 women who underwent balloon tamponade for severe PPH, during a period of 5 years and 10 months, at Russells Hall Hospital, a busy district general hospital in UK. Clinical success was defined as control of bleeding without need for further intervention. Results: Fifty-eight women (mean age, 30 years; range, 18 - 42) underwent balloon tamponade, of which twenty seven (46.5%) women delivered vaginally and 31 (53.5%) women were delivered by cesarean section. Uterine atony was the main cause of PPH (31 cases). Balloon tamponade was used prophylactically in 11 high risk women in anticipation of potential PPH. Rusch balloon was used in 48 cases and Bakri balloon in 10 cases. Clinical success rate of balloon tamponade was 87.2%. Three patients in this study required hysterectomy. Conclusion: Balloon tamponade is an effective means of controlling severe PPH with success rates of around 87%. There should also be a low threshold for prophylactic use of balloon tamponade in women at high risk of PPH, considering its ease of use, low complication rate and ability to maintain reproductive ability.


Cite this paper
Tirumuru, S. , Saba, S. , Morsi, H. and Muammar, B. (2013) Intrauterine balloon tamponade in the management of severe postpartum hemorrhage: A case series from a busy UK district general hospital. Open Journal of Obstetrics and Gynecology, 3, 131-136. doi: 10.4236/ojog.2013.31A025.
References
[1]   World Health Organization (2007) Making pregnancy safer. Reducing the global burden: Postpartum hemorrhage. http://www.who.int/maternal_child_adolescent/documents/newsletter/mps_newsletter_issue4.pdf

[2]   Lewis, G. (2007) The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving mothers’ lives: Reviewing maternal deaths to make motherhood safer—2003-2005. The Seventh Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. CEMACH, London.

[3]   NHS Quality Improvement Scotland (2010) Scottish confidential audit of severe maternal morbidity 2009. 7th Annual Report, NHS Quality Improvement Scotland, Edinburgh.

[4]   Knight, M., Kurinczuk, J., Spark, P. and Brocklehurst, P. (2008) Cesarean delivery and peripartum hysterectomy. Obstetrics and Gynecology, 111, 97-105. doi:10.1097/01.AOG.0000296658.83240.6d

[5]   Doumouchtsis, S.K., Papageorghiou, A.T. and Arulkumaran, S. (2007) Systematic review of conservative management of postpartum hemorrhage: What to do when medical treatment fails. Obstetrical and Gynecological Survey, 62, 540-547. doi:10.1097/01.ogx.0000271137.81361.93

[6]   Baskett, T.F. (1999) Complications of the third stage of labour. In: Essential Management of Obstetrical Emergencies. 3rd Edition, Clinical Press, Bristol, 196-201

[7]   Kayem, G., Kurinczuk, J.J., Alfirevic, Z., Spark, P., Brocklehurst, P. and Knight, M. (2011) Specific secondline therapies for postpartum haemorrhage: A national cohort study. British Journal of Obstetrics and Gynaecology, 118, 856-864. doi:10.1111/j.1471-0528.2011.02921.x

[8]   Georgiou, C. (2009) Balloon tamponade in the management of postpartum haemorrhage: A review. British Journal of Obstetrics and Gynaecology, 116, 748-757. doi:10.1111/j.1471-0528.2009.02113.x

[9]   Goldrath, M.H. (1983) Uterine tamponade for the control of acute uterine bleeding. American Journal of Obstetrics and Gynecology, 147, 869-872.

[10]   Ishii, T., Sawada, K., Koyama, S., Isobe, A., Wakabayashi, A., Takiuchi, T., et al. (2012) Balloon tamponade during cesarean section is useful for severe post-partum hemorrhage due to placenta previa. Journal of Obstetrics and Gynecology Research, 38, 02-07

[11]   Keriakos, R. and Mukhopadhyay, A. (2006) The use of the Rusch balloon for management of severe postpartum haemorrhage. Journal of Obstetrics and Gynaecology, 26, 335-338 doi:10.1080/01443610600595077

[12]   Tattersall, M. and Braithwaite, W. (2007) Balloon tamponade for vaginal lacerations causing severe postpartum haemorrhage. British Journal of Obstetrics and Gynaecology, 114, 647-648. doi:10.1111/j.1471-0528.2007.01278.x

[13]   Condous, G.S., Arulkumaran, S., Symonds, I., Chapman, R., Sinha, A. and Razvi, K. (2003) The “tamponade test” in the management of massive postpartum hemorrhage. Obstetrics and Gynaecology, 101, 767-772. doi:10.1016/S0029-7844(03)00046-2

[14]   Seror, J., Allouche, C. and Elhaik, S. (2005) Use of Sengstaken-Blakemore tube in massive postpartum hemorrhage: A series of 17 cases. Acta Obstetricia et Gynecologica Scandinavica, 84, 660-664.

[15]   Treloar, E., Anderson, R., Andrews, H. and Bailey, J. (2006) Uterine necrosis following B-Lynch suture for primary postpartum haemorrhage. British Journal of Obstetrics and Gynaecology, 113, 486-488. doi:10.1111/j.1471-0528.2006.00890.x

[16]   Lodhi, W., Golara, M., Karangaokar, V. and Yoong, W. (2012) Uterine necrosis following application of combined uterine compression suture with intrauterine balloon tamponade. Journal of Obstetrics and Gynaecology, 32, 30-31. doi:10.3109/01443615.2011.614972

[17]   Diemert, A., Ortmeyer, G., Hollwitz, B., Lotz, M., Somville, T., Glosemeyer, P., et al. (2012) The combination of intrauterine balloon tamponade and the B-Lynch procedure for the treatment of severe postpartum hemorrhage. American Journal of Obstetrics and Gynecology, 206, e1-e4.

[18]   Thapa, K., Malla, B., Pandey, S. and Amatya, S. (2010) Intrauterine condom tamponade in management of post partum hemorrhage. Journal of Nepal Health Research Council, 8, 19-22

[19]   Stavroulis, A., Memtsa, M., Aref-Adib, M., Fakokunde, A. and Yoong, W. (2009) Management of postpartum haemorrhage with Bakri balloon Tamponade. International Journal of Gynaecology and Obstetrics, 107, S348.

 
 
Top