Solution to Technical Difficulties of Uterine Balloon Tamponade Placement in Primary PPH Management: A Retrospective Case Series

Abstract

Objective: The aim of this study was to devise and enforce a simple yet effective method of condom placement for IUBT while dealing with all the technical difficulties in a poor resource setup to control primary PPH to save life of mother. Methodology: It is a retrospective case series study that is based on the hospital data obtained from Gynecology and Obstetrics Department of Sheikh Zayed Hospital, Rahim Yar Khan for a period of 8 months (July 2019 to Feb 2020) . Patients with persistent primary PPH after medical management who were given intra-uterine balloon tamponade (IUBT) were included in this study after evaluation for possible risk factors of PPH. Sample size was kept 30 with power of test at 80% and level of significance at 5%. Statistical assessment of the variables was done and the data was analyzed with SPSS v.21. Results: The 30 female patients, included in this study, had mean age of 30.3±6.06 years ranging from 17 to 39 years. Condom IUBT was successfully placed in 28(93.3%) patients by using 4 ring forceps applied on cervix and tied together with a gauze to keep the balloon in utero in order to control bleeding of PPH while in 2(6.66%) patients; it was unsuccessful due to inexperience of the operating staff. Out of these 28 patients with successful IUBT placement, condom based intra-uterine balloon tamponade was successful in controlling bleeding of PPH in 26(92.86%) patients while in 2(7.14%) patients, bleeding was not controlled and they underwent surgical interventions. Conclusion: Condom based Intra-uterine balloon tamponade is a simple yet effective method to control bleeding in primary postpartum hemorrhage but needs positive re-enforcement in the form of awareness/training sessions for the healthcare staff. Keywords: Catheter, Post-Partum Morbidity, Condom, Intra-Uterine Balloon Tamponade, Hemorrhage, Hysterectomy