Comparative Evaluation of Santharam Cannula vs Conventional Balloon Tamponade in Atonic Postpartum Hemorrhage: A Prospective Interventional Study in a Tertiary Care Setting

Risk of postpartum hemorrhage according to the ultrasound measurement of the lower uterine segment before delivery of women with a prior cesarean delivery: secondary exploratory research of the Lower Uterine Segment Trial.

Vacuum-induced tamponade using urological catheters for postpartum hemorrhage.

Postpartum hemorrhage (PPH) is a serious obstetric complication requiring urgent intervention and occurs in 3–10% of deliveries. PPH remains one of the leading causes of maternal morbidity and mortality, with approximately 80% of cases associated with ute­rine atony. Therefore, the implementation of new therapeutic approaches for atonic PPH in obstetric practice is of great importance.The objective: to evaluate the clinical effectiveness of a low-pressure vacuum system (LPVS) as a novel treatment for massive refractory atonic hemorrhage in a woman after vaginal delivery.Clinical case. A patient L., 34 years, delivered vaginally for the third time, at 39 weeks of gestation, with a cephalic presentation (fetal birth weight – 3,140 g, fetal length – 50 cm) at the Kyiv Regional Perinatal Center. Despite active management of the III stage of labor, it was complicated by retention of a placental lobe and fetal membranes in the uterine cavity and the development of early PPH. Manual uterine revision was performed with removal of retained placental tissue and membranes, followed by administration of uterotonic agents and tranexamic acid; uterine balloon tamponade was applied. Despite these measures, atonic PPH persisted and was classified as massive atonic hemorrhage, with blood loss reaching 1,500.0 mL. Therefore, it was decided to insert a LPVS into the uterine cavity. Negative pressure of 70–80 mmHg maintained for 1.5 hours. During this period, approximately 100.0 mL of liquid blood drained through the silicone tube. The atonic hemorrhage was successfully stopped without surgical hemostasis.Conclusions. The proposed method of LPVS placing intrauterine during the vaginal delivery can be considered as a highly effective, accessible, and cost-effective technique alternative to balloon tamponade and surgical methods for the treatment of refractory atonic hemorrhage.

Background: Postpartum hemorrhage (PPH) remains one of the leading causes of maternal morbidity and mortality worldwide. When medical and conservative measures fail to control hemorrhage, surgical interventions such as internal iliac artery ligation (IIAL) become essential to reduce pelvic blood flow and achieve hemostasis. Internal iliac artery ligation is considered an important fertility-preserving procedure in the management of severe obstetric hemorrhage. Objectives: To find out the efficacy of Internal Iliac artery ligation (IIAL) in postpartum haemorrhage and its maternal outcomes. Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynaecology of a tertiary care teaching hospital over a period of 18 months. A total of 70 women with postpartum hemorrhage requiring internal iliac artery ligation were included. Data regarding demographic characteristics, gestational age, referral status, mode of delivery, indications for internal iliac artery ligation, intraoperative findings, blood loss, blood transfusion requirements, associated surgical procedures, and postoperative outcomes were collected using a structured proforma. Data were analyzed using descriptive statistics and expressed as frequencies and percentages. Results: The majority of patients were aged 21-25 years (44.2%) and most deliveries occurred at term (>37 weeks) (45.7%). Caesarean section was the mode of delivery in 82.8% of cases. The most common indication for internal iliac artery ligation was atonic postpartum hemorrhage (27.1%), followed by placenta previa (24.2%) and abruptio placenta (17.1%). Uterine artery ligation (80%) and B-Lynch/Hayman sutures (28%) were commonly performed adjunct procedures. Blood loss exceeded 2000 ml in 50% of patients, and most required 4-5 units of blood transfusion. More than half of the patients required ICU stay for 1-2 days. Conclusion: Internal iliac artery ligation is an effective and life-saving surgical procedure for controlling severe postpartum hemorrhage and plays a vital role in fertility preservation when conservative management fails.

Introduction: Operative vaginal birth remains an important part of modern obstetric care and is used to achieve or expedite safe vaginal birth for maternal or foetal indications avoiding unnecessary caesarean birth. However, the use of obstetric forceps or vacuum extractor requires an obstetrician to be familiar with the proper use of the instruments and the risks involved. Objective: To evaluate the maternal and neonatal outcomes following vacuum assisted vaginal delivery. Materials and Methods: A hospital based cross-sectional study was conducted among 250 pregnant women (125 delivered by ventouse assisted vaginal delivery and 125 delivered by normal vaginal delivery) for a period of one and half years in the Department of Obstetrics and Gynaecology, Regional Institute of Medical Sciences, Imphal. Maternal outcomes like atonic PPH, Traumatic PPH, extension of episiotomy, 3rd degree perineal tear; and neonatal outcomes like birth weight, Apgar scores, NICU admission were compared between the two groups. Descriptive statistics like mean, standard deviation and percentage were used. The data was analyzed using SPSS version 21.0 IBM. Data analysis was done using Chi square test and t-test and p- value < 0.05 was taken as significant. Results:The average age among vacuum delivered women was 28 years. Most of the women who underwent vacuum assisted vaginal deliveries were primigravida accounting for 46.4% of the cases. The most common reason for vacuum delivery was poor maternal effort (31.2%) followed by prolonged 2nd stage of labour (28%) and foetal distress (26.4%). Maternal complications rate among the vacuum delivery was 8.8% in this study, the most common complication being atonic post-partum haemorrhage (4%). Apgar score below 4 at 1min and 5 min was also seen only in few cases of vacuum assisted delivery (2.4% and 0.8% respectively). And NICU admission was also seen among vacuum assisted vaginal deliveries only (4.8%). Conclusion: Vacuum-assisted vaginal delivery is a valuable and generally safe obstetric procedure when used for appropriate indications and under recommended clinical conditions.

Background: Emergency peripartum hysterectomy (EPH) is a life-saving procedure performed to control intractable obstetric hemorrhage. The incidence and indications have evolved over time, necessitating contemporary analysis. Objective: To analyze the incidence, risk factors, indications, and fetomaternal outcomes of peripartum hysterectomy at a tertiary care hospital in South India. Methods: A prospective observational study was conducted at Government Raja Mirasudhar Hospital, Thanjavur for a period of 12 months. All cases of peripartum hysterectomy were analyzed for demographic characteristics, indications, risk factors, surgical details, and maternal and neonatal outcomes. Results: Among 18,527 deliveries, 46 peripartum hysterectomies were performed, yielding an incidence of 2.5 per 1,000 deliveries (0.2%). The incidence was higher following cesarean section (4.8/1000) compared to vaginal delivery (0.7/1000). The majority of women (71.7%) were aged 25-34 years, and 89.1% were multiparous. Abnormally invasive placenta was the leading indication (60.9%), followed by intractable atonic postpartum hemorrhage (32.6%). Major risk factors included multiparity (89.1%), previous cesarean sections (82.9%), and placenta previa (60.9%). Maternal complications included coagulopathy (28.3%), febrile episodes (26.1%), and acute kidney injury (23.9%). Maternal mortality was 4.3%, and perinatal mortality was 12.8%. Conclusion: The incidence of peripartum hysterectomy remains significant, with abnormally invasive placenta being the predominant indication. Previous cesarean sections emerged as a major risk factor, highlighting the importance of judicious use of primary cesarean delivery.

Objectives and background:The World Health Organization (WHO) defines postpartum hemorrhage (PPH) as blood loss of 500 mL or more within the first 24 hours after birth.It accounts for 35% of maternal deaths worldwide.Transfusion of blood and blood products has become a vital part of PPH management.In recent times, the Samartha Ram (SR) cannula commonly referred to as the SR cannula is being widely used in the management of PPH in many tertiary centers in India.This study aims at correlating the decrease in the need for blood transfusion in cases of PPH managed with the SR cannula.Materials and methods: This retrospective cohort study was done at the Institute of Social Obstetrics, Government Kasturba Gandhi Hospital for Women and Children, Chennai.The study sample involved a cohort of mothers admitted in ISO Govt KGH spanning a period of 1 year (January 2022 to December 2022) requiring management for PPH.The study analyzed the impact of employing the SR cannula in the management of PPH on the requirement for blood transfusions.Results: Our findings revealed the following distribution of blood transfusions among the study participants: 28 women (20.74%) received one unit of packed cell volume (PCV); seven women (5.10%) required two units of PCV; and three women (2.22%) necessitated three units of PCV.Remarkably, 97 women (71.8%) experienced PPH management without any need for blood transfusion. Conclusion:Our study underscores the importance of integrating the SR cannula as a standard component of the obstetric toolkit for managing PPH efficiently.This simple, cost-effective technique facilitates rapid hemostasis, demands minimal training, safeguards uterine integrity, and significantly reduces blood loss compared to more invasive interventions like hysterectomy.In light of these findings, we advocate for the widespread adoption of the SR cannula in the management of PPH cases, not only in our study hospital but potentially in other healthcare facilities as well.By reducing the need for blood transfusions and offering a safe and accessible alternative, the SR cannula can contribute substantially to maternal healthcare, particularly in resource-constrained settings, ultimately improving maternal outcomes and reducing the burden of PPH-related maternal mortality.

Background: The second stage of labour, extending from full cervical dilatation to fetal delivery, represents a critical interval during which surgical intervention may become necessary. Cesarean sections performed at full dilatation encounter formidable technical challenges due to deep fetal head engagement within the maternal pelvis, substantially elevating the risk of maternal haemorrhage, tissue trauma, and neonatal hypoxic injury compared with first-stage procedures.?Objectives: This study aimed to systematically characterise the clinical indications, maternal perioperative complications, and neonatal outcomes associated with second-stage cesarean delivery in a tertiary obstetric centre.Materials and Methods: A cross-sectional observational investigation was conducted at the Department of Obstetrics and Gynaecology, Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur, India, enrolling 100 consecutive women undergoing cesarean section during the second stage of labour. Structured data collection incorporated demographic variables, obstetric history, intraoperative events, and both maternal and neonatal outcomes.?Results: Non-progression of labour (28%) and fetal distress (19%) constituted the predominant indications for surgical intervention. Maternal morbidity affected 54% of the cohort, with atonic postpartum haemorrhage (20%), blood transfusion requirement (22%), and uterine incision extension (18%) representing principal intraoperative complications. Postoperative sequelae included prolonged hospitalisation (28%) and paralytic ileus (18%). Neonatal outcomes revealed that 39% required neonatal intensive care unit admission, predominantly for meconium aspiration syndrome (48.7%) and hypoxic–ischaemic encephalopathy (17.9%), whilst perinatal mortality remained low at 3%.?Conclusion: Second-stage cesarean sections are accompanied by substantial fetomaternal morbidity, necessitating meticulous surgical technique, skilled operative teams, and comprehensive perioperative preparation to optimise outcomes in this high-risk obstetric scenario.

Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide. Timely placental separation and effective uterotonic therapy are critical components in the prevention and management of PPH. Oxytocin has been the gold standard for uterotonic use; however, newer agents such as carbetocin offer longer duration of action and may improve maternal outcomes. Comparative evaluation of these agents in both vaginal and cesarean deliveries is essential for optimizing clinical protocols. The aim of this study was to compare the efficacy of carbetocin and oxytocin in promoting placental separation and controlling PPH following normal vaginal delivery (NVD) and lower segment cesarean section (LSCS). This prospective, comparative observational study was conducted at the Department of Obstetrics and Gynaecology, Dr. D. Y. Patil Medical College, Pune, over a period of 2 years from November 2022 to October 2024. A total of 200 women were enrolled and divided equally into two groups: Group A received 100 μg of intravenous carbetocin, and Group B received 10 IU of intravenous oxytocin. Each group included an equal number of women undergoing NVD and LSCS. Outcomes assessed included time for placental separation, duration of the third stage of labor, estimated blood loss, requirement for additional uterotonics, and incidence of PPH. The mean time to placental separation and third-stage duration were significantly shorter in the carbetocin group compared to the oxytocin group. Carbetocin was also associated with reduced intraoperative and postpartum blood loss and a lower need for additional uterotonic agents. The incidence of atonic PPH was notably lower in the carbetocin group, both in vaginal and cesarean deliveries. Carbetocin is more effective than oxytocin in achieving faster placental separation, reducing third-stage labor duration, minimizing blood loss, and lowering the risk of atonic PPH in both normal and operative deliveries. Its longer duration of action and reduced need for repeat dosing make it a superior uterotonic agent for PPH prophylaxis.

Background: The most prevalent and potentially life-threatening consequence of giving birth is obstetric haemorrhage. Postpartum haemorrhage (PPH) has traditionally been described as blood loss during birth that is larger than 500 mL for vaginal delivery or 1000 mL for caesarean delivery. Aim: To evaluate the safety and efficacy of two drugs for the prevention of postpartum haemorrhage (PPH) after caesarean section: intraoperative intravenous oxytocin and ergometrine, and intravenous carbetocin, a long-acting oxytocic analogue. Subjects and methods: This prospective randomized study was done on 100 patients at El-Hussein hospital, El-Azhar University in Cairo, from the beginning of January 2021 to the end of September 2024. The studied patients were divided into two equal groups. Results: Both groups were matched as regards the median maternal age, parity, and GA, which is in accordance with the accurate comparison outcomes in this study. When looking at the groups' medical and surgical histories, we also didn't find any statistically significant differences. Regarding pre-operative haemoglobin (10.3 vs. 10.8 in groups A and B, respectively) and HCT (30.9 vs. 31.3 in groups A and B, respectively), no statistically significant differences were found. Additionally, there was no statistically significant variation between postoperative haemoglobin and HCT. Conclusion: Compared to a combination of intraoperative intravenous oxytocin 10 I.U. and ergometrine 0.2 mg intramuscular, giving 100µg of intravenous carbetocin is more effective in preventing atonic postpartum haemorrhage in caesarean births that occur at a gestational age (GA) greater than 37 weeks, with less postpartum haemorrhage (PPH).

As the leading cause of maternal mortality, the pathogenesis of postpartum hemorrhage (PPH), with 60%-70% cases of uterine atony, remains unclear due to a fundamental lack of animal models for studying. Our study develops a novel placenta-targeted nanodelivery system, termed HN@DC NPs, which is formulated with DSPC (1,2-distearoyl-sn-glycero-3-phosphocholine), DSPE-PEG2000 (1,2-distearoyl-sn-glycero-3-phosphoethanolamine-N-[methoxy (polyethylene glycol)-2000]), and DSPE-PEG-CSA (DSPE-PEG2000-chondroitine sulfate A). This system is designed to co-deliver key inflammatory mediators-nucleotide-binding oligomerization domain, leucine-rich repeat, and pyrin domain-containing 3 (NLRP3) agonist nigericin and high mobility group box-1 protein (HMGB1), which are identified from pregnant women with atonic PPH to establish a pathophysiologically relevant animal model. The HN@DC NPs achieve precise enrichment in placental trophoblasts and effective diffusion into decidua with good short-term biocompatibility. The pregnant rats model constructed by HN@DC NPs shows prolonged labor duration and weakened uterine smooth muscle contractility with the activation of inflammatory markers in the placental decidua. The new insight into a reproducible construction strategy of the atonic PPH animal model in this study promotes the mechanism research and clinical therapeutic development of atonic PPH.

Objective.Emergency obstetric hysterectomy (EOH) is a life-saving procedure when all other measures fail to control haemorrhage in obstetric emergencies.Our hospital based M a n u s c r i p t a c c e p t e d f o r p u b l i c a t i o n 2 retrospective study aims to evaluate the incidence, demographic profile, risk factors, clinical indications, and outcomes associated with EOH. Materials and Methods.A retrospective analysis was conducted encompassing 34 cases of EOH out of 12,782 deliveries within a duration of 4 years and 2 months.Variables examined included maternal demographics, obstetric history, surgical indications, perioperative complications, maternal and foetal outcomes.Results.The incidence of EOH was 0.26% (1 in 376 deliveries).The median maternal age was 31 years, with multigravida status in 85.3% of cases.A history of caesarean section was documented in 76.5%, and placenta previa in 44.1%.PAS constituted the leading indication (58.8%) for EOH, followed by atonic postpartum haemorrhage (20.6%) and uterine rupture (20.6%).Primary mode of delivery was caesarean section in our cases (82.3%).Postoperative intensive care was required in 88.2% of cases, with major complications comprising anaemia (70.6%) followed by haemorrhagic shock (29.4%).Maternal mortality was observed in 5.8% of cases and foetal mortality predominantly was attributed to prematurity, with neonatal survival in 67.6% cases. Conclusions.EOH remains indispensable for life-threatening obstetric emergencies.The predominance of PAS underscores the necessity for judicious use of caesarean section.Enhanced antenatal risk stratification and robust tertiary support infrastructure, including rapid-access blood bank and intensive care facilities, will help to optimize maternal and neonatal outcomes

Background: Postpartum haemorrhage (PPH) is a major cause for maternal morbidity and deaths worldwide. They affect 14 million women and cause 70,000 deaths annually on a global level. Uterine atony is failure of uterus contraction after childbirth and major cause of PPH. This study evaluates the efficiency of SR suction cannula in managing atonic PPH. Methods: A prospective interventional study was carried out at Sri Siddhartha Medical College and Hospital, Tumakuru for over 18 months and involved 125 women at risk of developing PPH. The study included women with atonic PPH and excluded those with other causes of PPH or pre-existing coagulation disorders. The SR suction cannula has been connected to a suction machine and maintains a negative pressure of 650mmHg. Then it was used to evacuate the uterine cavity and its efficiency in controlling haemorrhage was assessed. Results: The majority of patients (83.1%) experienced blood loss between 151 to 200 ml. In most cases the bleeding cessation is within 2 to 4 minutes. The average level haemoglobin showed a statistically significant decrease from the time of diagnosis to 24 hours post intervention. 80% of the patients did not require further intervention after using the SR suction cannula, thus indicating its effectiveness in managing atonic PPH. Conclusion: The SR suction cannula is a safe, efficient, and cost-effective tool for managing atonic PPH. This also reduces the need for invasive procedures and improves maternal outcome.

Background: Postpartum haemorrhage (PPH) remains a major cause of maternal morbidity and mortality, particularly in low-resource settings. Early identification of risk factors and timely intervention are essential to improving outcomes. This study investigates the aetiologies, risk factors, management patterns, and outcomes of PPH in a tertiary care centre. Methods: A prospective observational study was conducted on 80 cases of PPH among 14, 442 deliveries between August 2022 and July 2024. Detailed clinical assessment, quantification of blood loss, laboratory evaluation, and management according to institutional protocols were undertaken. The findings were compared with established national and international literature. Results: Primary PPH accounted for 92.5% of cases. Emergency or referred admissions constituted 80%, while 20% were registered patients. Most affected women were aged 25-30 years (50%). Uterine atony was the predominant cause (64.86%), followed by traumatic PPH (27.02%). Significant risk factors included previous caesarean section (25%), multigravidity (16.66%), placenta previa (12.5%), anaemia (14.5%), preeclampsia (8.3%), and placental abruption (8.3%). Medical management alone was effective in 32.5% of atonic PPH cases, primarily using oxytocin and misoprostol; uterine tamponade was used in selected cases. Surgical intervention was required in 67.5% of cases, including uterine artery ligation, internal iliac ligation, repair of genital tract injuries, manual removal of placenta, and one hysterectomy. Postoperative complications occurred in 18 patients. Maternal mortality was 2.5%, with deaths due to acute renal failure with DIC and dilated cardiomyopathy. Blood component therapy was required in most patients. Conclusion: PPH is a preventable emergency requiring rapid recognition, coordinated multidisciplinary care, and access to effective medical and surgical interventions. Strengthening antenatal care and emergency referral systems can significantly reduce PPH-related maternal morbidity and mortality.

Postpartum hemorrhage (PPH) is one of the main emergency obstetric complications, with an incidence ranging from 1.0 to 10.0% of the total number of births. Uterine atony, the main cause of PPH, accounts for 70 to 80% of these hemorrhages and, in most cases, occurs within the first 2 hours after childbirth.The objective: to evaluate the clinical effectiveness of using the new domestic vacuum system RENIS-1 (remodeling of the lower uterine segment) to prevent atonic PPH in high-risk women giving birth vaginally.Materials and methods. Between 2022 and 2024, a prospective randomized study was conducted at the clinical bases of the Department of Obstetrics and Gynecology No. 1 of Shupyk National Healthcare University of Ukraine and included 77 women at high risk of developing hemorrhagic complications who had vaginal births. Women were divided by simple randomization into two groups: I group (interventional group, n = 41) – after the birth of the placenta, the RENIS-1 interventional technique with low-pressure vacuum (80–90 mmHg) was used to prevent the development of atonic PPH in combination with intramuscular administration of 10 IU of oxytocin; II group (control one, n = 36) – patients were performed only standard prophylaxis according to the protocol of active management of the third stage of labor: administration of 10 IU of oxytocin without additional interventions (in accordance with the order of the Ministry of Health of Ukraine No. 205 dated March 24, 2014).To assess the effectiveness of the method, the frequency of atonic PPH development was determined in the first 2 hours after childbirth, as well as the volume of blood loss in the early postpartum period, which was measured by the gravimetric method. Pathological blood loss defined as 500.0 mL or more.Results. Pregnant women in both groups were representative in terms of age, gestational age, mode of delivery, and the number of risk factors for developing PPH (p &gt; 0.05). The main risk factors for PPH in both groups were: large fetus, polyhydramnios, multiple pregnancy, a history of PPH. In I group, the average blood loss, the rate of atonic hemorrhages, the need for blood transfusions, and the need for additional uterotonic drugs were significantly lower compared to II group (p &lt; 0.01).Conclusions. The prophylactic use of the RENIS-1 low-pressure vacuum technique in high-risk pregnant women for develo-ping PPH undergoing vaginal delivery significantly reduces blood loss, decreases the frequency of atonic hemorrhages in the early postpartum period, and the need for blood transfusions and use of additional uterotonic drugs.

Abstract Background: Fetomaternal outcome is affected by postdatism in pregnancy. This study was conducted to evaluate the fetomaternal outcome in postdated pregnancies. Materials and Methods: The present longitudinal study was done in 100 postdated pregnancy patients who were admitted in the obstetrics ward at a tertiary care center from November 2023 to July 2024. Results: In the present study, out of 100 subjects, 33 (33%) had vaginal delivery and 67 (67%) had cesarean delivery. Major indication for cesarean section (CS) was fetal distress in 40.25% and nonprogress of labor in 18% of cases among lower segment CS. The proportion of low birth weight babies to postdated mothers was 26% (95% confidence interval [CI] 17.7%–35.7%). Maternal complications were seen in 5 (5%) (95% CI 1.6%–11.3%) of the postdated mothers in the form of atonic postpartum hemorrhage (PPH). Fetal complications were found in 26% (95% CI 17.7%–35.7%) of the newborns. Conclusion: Postdated pregnancy was associated with increased risk of obstetric complications like PPH. There was increased risk of neonatal intensive care unit admissions with perinatal complications such as fetal distress, meconium aspiration syndrome, fetal asphyxia, neonatal jaundice, and macrosomia. Management of postdated pregnancy should be done carefully and systematically to avoid maternal and fetal complications.

Introduction: We aim to determine the comparative effectiveness of heat-stable carbetocin (HSC) versus oxytocin for the prevention of atonic postpartum haemorrhage (PPH) at a tertiary care centre in Central India.Method: This study is a prospective observational study conducted over 18 months (January 2023 to July 2024) and included 284 low-risk gravid women in labour at term after obtaining ethical approval and informed consent. There were 142 participants in each group. Group 1 received heat-stable carbetocin 100 mcg, and group 2 received oxytocin 10 units intramuscularly within one minute of delivery. Women with medical or obstetrical disorders were excluded. The primary objective was to compare the incidence of atonic PPH among participants receiving carbetocin versus oxytocin after the delivery of the baby. The secondary objective was to estimate the mean blood loss (MBL) and change in the haemoglobin (Hb) level before and after delivery in the two groups. Blood loss was estimated by quantifying blood loss by adding up the volumetric component (using a calibrated drape or suction bottle) to the gravimetric estimate. The incidence of PPH and the mean blood loss were noted. The degree of haemoglobin decline before and after delivery was also recorded. Statistical significance was assessed using Student’s t-test and chi-square test, and a p-value of <0.05 was taken as significant.Result: The incidence of PPH was comparatively less in women in the carbetocin group (group 1) when compared with those in the oxytocin group (group 2), although not statistically significant (4.2% versus 7%, respectively; p=0.303). A significant difference was observed in the mean blood loss, being less with carbetocin (623±81.3 versus 678±88.7 mL; p=0.039). Haemoglobin decline was also found to be less in those receiving carbetocin (p<0.001).Conclusion: Although insignificant statistically, carbetocin plays an effective role in preventing PPH when compared to oxytocin, particularly in settings where cold chain maintenance for oxytocin transport and storage remains doubtful. Statistically significant lower mean blood loss with carbetocin can be an added advantage.

ABSTRACTBackground:Postpartum hemorrhage (PPH) affects approximately 14 million women globally each year and accounts for around 70,000 maternal deaths, according to the World Health Organization (WHO). Between 54% and 93% of maternal deaths due to obstetric hemorrhage are considered preventable. To reduce this burden, healthcare strategies are increasingly emphasizing cost-effective, accessible, and efficient treatment approaches.Objective:To evaluate the effectiveness of condom-catheter balloon tamponade in managing atonic PPH.Method:A 3-year prospective study at Rajarshi Dashrath Autonomous State Medical College, Ayodhya, involving 194 women with atonic PPH unresponsive to medical treatment.Result:The tamponade-controlled bleeding in 100% of cases, with most arrests occurring within 15 minutes. No complications were reported.Conclusion:Condom-catheter balloon tamponade is a safe and highly effective method for managing atonic PPH.

Background: Postpartum hemorrhage (PPH) is a leading cause of maternal mortality in Bangladesh. Low-cost condom catheter balloon tamponade (CCBT) has emerged as a promising second-line intervention following failure of uterotonics, yet local evidence from northeastern Bangladesh remains scarce. Objective: To evaluate the efficacy and safety of CCBT for managing refractory atonic PPH in a tertiary care hospital in Sylhet. Methods: A prospective observational study was conducted at North East Medical College &amp; Hospital from July to December 2024. Fifty women aged 18–45 with primary PPH unresponsive to oxytocin ± misoprostol were treated with intrauterine CCBT. Primary outcome was bleeding control within 6 hours without surgical intervention. Secondary outcomes included residual hemorrhage, hemoglobin drop, blood transfusion requirements, device-related complications, duration of hospitalization, and maternal mortality. Results: CCBT achieved successful hemorrhage control in 43/50 patients (86%). Seven patients (14%) required surgical procedures: B‑Lynch sutures (n=3), uterine artery ligation (n=2), and hysterectomy (n=2). After balloon insertion, mean residual blood loss was 300 ± 120 mL. Mean hemoglobin decline was 3.1 ± 0.9 g/dL, with transfusion averaging 2.7 ± 1.0 units. Device-related complications were minimal: one infection (2%) and two cases of slippage (4%), with no maternal deaths. Average hospital stay was 5.1 ± 1.7 days. Comparative analysis revealed significantly greater initial blood loss, residual bleeding, and transfusion needs in the failed intervention group (p &lt; 0.05). Conclusion: In this resource-constrained setting, CCBT provided effective, safe, and rapid hemorrhage control in 86% of refractory PPH cases, with a low complication profile and no maternal fatalities. Early intervention prior to massive blood loss appears critical for success. These findings support the wider adoption of CCBT with structured training and guideline integration across similar healthcare systems in Bangladesh.