Abstract
Objective| To compare the effectiveness and safety profile of intrauterine balloon tamponade with uterovaginal roll gauze packing among patient of primary postpartum hemorrhage after normal vaginal delivery. Duration of Study| This study was conducted in the Department of Obstetrics & Gynaecology, of a Tertiary Care Hospital, Lahore from December 2015 to November 2016. Patients and Methods| In this Randomized controlled trial,212 patients of age range 20 to 40 years who presented with postpartum hemorrhage after a normal vaginal delivery (NVD) those who did not responded to medical treatment were included. Cases of PPH due to perineal, cervical or vaginal tear, episiotomy, retained placenta, coagulation disorder, secondary PPH and PPH with normal vaginal delivery after previous cesarean section were excluded from this study. Subjects were randomly assigned to either intrauterine balloon tamponade or uterovaginal roll gauze packing. Intrauterine packing (IP) was removed after 24 hours and balloon tamponade after 24 hours of insertion. Antibiotic coverage was also given to prevent intrauterine infection. All females were kept under observation in ward. Effectiveness was labeled if bleeding was stopped within 15 minutes after uterovaginal packing or balloon tamponade (BT) and patient remain hemodynamically stable and if no complications occur after applying or removing balloon tamponade or intrauterine packing safety was labeled. Data was analyzed by SPSS version 20.2.Frequencies and percentage of complications were calculated along with rate of successful cessation of bleeding were calculated. Result| Mean age group of woman in whom balloon tamponade and intrauterine packing was used was 29.22+6.52 and 29.05+ 6.802 years. Mean gestational age of woman in BT and IP group and was 39.95+1.304 and 38.98+ 1.428 years. Mean blood loss in woman in BT and IP group was 600.28+ 25.338 and 669.21+70.176 ml. Efficacy of group BT was 78(73.6%) and in IP was 63(59.4%).Safety of BT group was 97(91.51%) and IP group was 55(51.88%). Treatment of balloon tamponade was more effective and safe than intrauterine packing in female presented with PPH after normal vaginal delivery (p < .05). Conclusion| This study concluded that balloon tamponade is an effective and safe method than intrauterine packing for the management of PPH after normal vaginal delivery.
Highlights
Postpartum Hemorrhage (PPH) is an excessive blood loss of more than 500 ml in normal virginal birth of child from genital tract from time of delivery of the baby till the completion of puerperium i.e, 42 days after delivery
For the management of PPH different treatments of PPH are available, first we go for medical uterotonic agents and if not successful we proceed to interventional methods
Gray A et al found that balloon tamponade and uterovaginal packing group patients were younger as 27.17 + 3.542 year.4Dabelea V et al demonstrated that both treatment groups were more commonly found in younger age group (28 + 5.2) year.[5]
Summary
Postpartum Hemorrhage (PPH) is an excessive blood loss of more than 500 ml in normal virginal birth of child from genital tract from time of delivery of the baby till the completion of puerperium i.e, 42 days after delivery. This is big reason of death worldwide and especially in low income countries.[1]. The most common cause of PPH is uterine atony among other causes that include genital tract trauma, uterine rupture, retained placenta or part of placenta and coagulation disorders.[2] Common consequences of PPH are disseminated intravascular coagulopathy (DIC), hypovolemic shock, adult respiratory syndrome (ARDS) and hepatic and renal and hepatic failure which may end up in maternal death.[3]. Depending upon parity of patient and severity of PPH we choose the best options
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