Conservative management of massive postpartum hemorrhage using the intrauterine balloon-an effective alternative to hysterectomy

Abstract

THE INTRAUTERINE BALLOON-AN EFFECTIVE ALTERNATIVE TO HYSTERECTOMY SOHA SAID, FIONNUALA M. BREATHNACH, MICHAEL GEARY, FERGAL D. MALONE, Royal College of Surgeons in Ireland, Dublin, Ireland, Rotunda Hospital, Dublin, Ireland OBJECTIVE: To describe the role of the intrauterine balloon as an effective alternative to hysterectomy when faced with massive postpartum hemorrhage. STUDY DESIGN: All cases of massive postpartum hemorrhage requiring transfusion at a single large obstetric centre were reviewed. Information regarding demographic background, labor and delivery details, medical and surgical interventions, and outcome were recorded. RESULTS: During the study period from January 2005 to June 2006 there were 114 cases of massive postpartum hemorrhage requiring transfusion, out of cohort of 9,386 deliveries (1.2%). In 8 of thses cases (7%) the Rusch intrauterine balloon was used when medical management of uterine atony failed. Mean maternal age was 32 years (range 21-40) mean duration of labor was 4.5 hours (range 3-12), and 5 (63%) were multiparous. Mode of delivery was vaginal in 6 cases (75%), and cesarean in 2 (25%). Mean transfusion requirement was 6 units (range 3-15). In all 8 cases, hemorrhage was successfully controlled following placement of the balloon. Mean duration of the balloon placement was 7 hours (range 4-18). CONCLUSION: Massive postpartum hemorrhage due to uterine atony that fails to respond to medical treatment is amongst the most common indications for emergency peripartum hysterectomy. The use of an intrauterine inflated catheter balloon for tamponade is an effective conservative technique for controlling hemorrhage, is inexpensive, simple to use and is not associated with significant morbidity. The intrauterine balloon should be considered as an alternative to hysterectomy whenever medical management of uterine atony fails.