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.
Highlights
Worldwide, obstetric hemorrhage remains a significant problem and is responsible for 127,000 deaths annually
The purpose of this study is to evaluate the effectiveness of balloon tamponade in Postpartum hemorrhage (PPH) management and to report our experience of its use in a busy district general hospital (5300 deliveries annually)
Notes were available for 58 women, who were the subject of the present study
Summary
Obstetric hemorrhage remains a significant problem and is responsible for 127,000 deaths annually. Postpartum hemorrhage (PPH) is the most common type of obstetric hemorrhage and accounts for the majority of the 14 million cases annually [1]. In the UK, deaths from obstetric hemorrhage are rare (0.8:100,000 births) [2]. According to the 2009 Scottish Confidential Audit of Severe Maternal Morbidity, major obstetric hemorrhage is the most common cause of severe maternal morbidity affecting 78% women with severe morbidity, giving a rate of 5.18 per 1000 live births in Scotland [3]. Hysterectomy is the ultimate measure to control bleeding and avoid maternal death. The rate of peri-partum hysterectomy, as reported by the UK Obstetric Surveillance System (UKOSS), is 0.41:1000 births [4]
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