Bimanual Compression Research Articles

Postpartum Hemorrhage et causa Atonia Uteri and Ruptured Portion with Complications of Shock Hemorrhagic and Anemia: A Case Report from Southwest Sumba, East Nusa Tenggara

Postpartum hemorrhage is one of the most common obstetric emergencies, and it is the most significant contributor to maternal mortality in the world. The most common cause is uterine atony, followed by laceration in the perineum or portion. P4A0 spontaneous postpartum at the primary health care facility (Puskesmas), a baby boy with a birth weight of 3000 grams cries spontaneously. After delivering the baby, the placenta was born 15 minutes later, with active bleeding afterwards of more than 1500 cc without uterine contractions. The patient was then diagnosed with spontaneous postpartum P4A0 with uterine atony, and the management of uterine atony was performed by massaging the fundus with external and internal bimanual compression, accompanied by fluid resuscitation by inserting a 2-line IV line. She was then given vaginal misoprostol, but contractions were still absent. She was then given a uterotonic drip of oxytocin (30 iu/30 dpm), and the contractions are getting better and stronger. Bleeding was evaluated, but still active then exploratorium on the birth canal and the source of the bleeding was found to be a portion of the tear from front to back, towards 5 o'clock. Then stitching was performed on the portion, and 1 hour after suturing, the bleeding was no longer active. The patient was treated at Puskesmas, with a final HB of 7.5 g/dL. To improve diagnosis accuracy and speed in handling emergency obstetric cases. Atonia uteri is caused by many factors, one of which is parturition as experienced by the patient. After active management of stage 3, bleeding continues, so that treatment is given, including the administration of crystalloid fluid, uterotonics, uterine massage, bimanual compression, and catheter condom placement. If the steps that have been taken have not stopped the bleeding, then the next intervention must be immediately taken, namely surgery. In cases of postpartum hemorrhage caused not by uterine atony but by a wound or tear in the portion, prompt actions must be taken to immediately eliminate bleeding by exploring and sewing the torn part and then re-evaluating to ensure that the bleeding stops. Establishing the right diagnosis in emergency cases of postpartum hemorrhage and providing prompt and appropriate treatment can prevent complications ranging from shock to death.

P₂A₀ 38-year-old Woman Postpartum Hemorrhage with Hemorrhagic Shock and Severe Anemia Caused by Uterine Atony: A Case Report from Southwest Sumba, East Nusa Tenggara

Postpartum hemorrhage is one of the most common obstetric emergencies and the largest contributor to maternal mortality in the world, with uterine atony being the most common cause. A 38-year-old woman came to Karitas Hospital complaining of vaginal bleeding after giving birth three hours ago. On examination, the patient was somnolent with signs of shock. Anemic conjunctiva, pale lips, weak contractions of the uterus, and active vaginal bleeding. The laboratory results show severe anemia and leukocytosis. The diagnosis was P2A0 38-year-old woman, postpartum spontaneously with hemorrhagic postpartum caused by uterine atony with hemorrhagic shock and severe anemia. The treatment was given according to the algorithm for managing postpartum hemorrhage. Uterine atony is caused by many factors, one of which is precipitous labor as experienced by the patient. Fluid rescucitation, uterotonics, uterine massage, bimanual compression, and the insertion of a condom catheter were given because there was still active bleeding after the 3rd stage of active management. Finally, surgical intervention should’ve been taken as the last step to stop the bleeding. Fast and precise handling can prevent complications of postpartum hemorrhage, namely shock and death.

Prevention of postpartum haemorrhage: Economic evaluation of the novel butterfly device in a UK setting

ObjectivesTo explore the cost-effectiveness of a novel PPH device as compared with usual care. DesignA decision analytical model was used to explore the cost-effectiveness of the PPH Butterfly device compared with usual care. This was part of a United Kingdom, UK, clinical trial ISRCTN15452399 using a matched historical cohort who had standard PPH management without the use of the PPH Butterfly device. The economic evaluation was conducted from a UK National Health Service (NHS) perspective. SettingLiverpool Women’s Hospital, UK. Participants57 women with 113 matched controls. InterventionThe PPH Butterfly is a novel device that has been invented and developed in the UK to facilitate bimanual compression of the uterus in the treatment of PPH. Main outcome measuresMain outcome measures included healthcare costs, blood loss, and maternal morbidity events. ResultsMean treatment costs in the Butterfly cohort were £3,459.66 as compared with standard care £3,223.93. Treatment with the Butterfly device resulted in decreased total blood loss in comparison with standard care. The Butterfly device had an incremental cost-effectiveness ratio of £3,795.78 per PPH progression avoided (defined as ≤ 1000 ml additional blood loss from device insertion point). If the NHS is prepared to pay £8,500 per PPH progression avoided, then the Butterfly device is cost-effective with a probability of 87 percent. In the PPH Butterfly treatment arm there were 9% fewer cases of massive obstetric haemorrhage (severe PPH of more than 2000mls or more than 4 units of blood transfusion required) recorded as compared with the standard care historical cohort. As a low-cost device, the PPH Butterfly device is cost-effective but can be cost-saving to the NHS. ConclusionThe PPH pathway can result in high-cost resource use such as blood transfusion or high dependence unit hospital stays. The Butterfly device is a relative low-cost device in a UK NHS setting with a high probability of being cost-effective. The National Institute for Health and Care Excellence (NICE) can use this evidence in considering the adoption of innovative technologies such as the Butterfly device in the NHS. Extrapolation on an international scale to lower and middle-income countries could prevent mortality associated with PPH.

PREVENTION AND TREATMENT OF POSTPARTUM HEMORRHAGE: A LITERATURE REVIEW

Background: The main cause of morbidity and maternal mortality is hemorrhage postpartum, with an increasing incidence around the world. Various risk factors for postpartum bleeding are expected to be an effective treatment by health professionals and have a role as advocates, collaborators, educators, service providers, and as researchers must have the latest knowledge in providing optimal and comprehensive care.
 Objectives: This study aimed to find out the prevention and treatment of hemorrhage postpartum.
 Design: This study design is a systematic review to search and review articles from database and the descriptive theory.
 Data Sources: Search scientific articles using the Mendeley application by entering the keywords "Postpartum, Hemorrhage, Prevention, and Treatment" with publication year 2019-2021, English, full text, and open access.
 Review Methods: The literature review method uses a narrative review to discuss postpartum hemorrhage, its prevention, and treatment. The inclusion criteria are the year of publication 2019-2021, international publications, articles in English, original articles, full text, and open access. Data were collected and a journal summary was made which included the name of the researcher, year of publication of the journal, research title, method, and a summary of the results or findings.
 Results: From 9 journals that meet the conclusion that active management of the third stage, administration of uterotonics and bimanual compression, is the initial treatment for the prevention and treatment of postpartum hemorrhage.
 Conclusion: In the prevention of risk factors for postpartum hemorrhage, it is recommended to carry out good active management of the third stage, use of uterotonic drugs according to the recommended dose, early initiation of breastfeeding, and increase the knowledge and skills of health workers.

Successful use of condom catheters for management of uterine inversion: Case report and literature review.

Introduction and importanceUterine inversion is a rare case but can lead to maternal death. Treatment options start from repositioning the uterus to surgery. Surgery should be prevented because this procedure is associated with complications and long-term effects on women. A case report describes the use of condom chateters in the management of bleeding due to uterine inversion.Case presentationMrs. SIM, a 35-year-old secondary primigravida woman, was referred from the midwife's independent practice 3 h after her third delivery with a diagnosis of uterine prolapse and hypovolemic shock. The patient successfully underwent a manual placenta but part of her uterus turned inside out accompanied by bleeding. At the referral hospital, the patient was diagnosed with uterine inversion. The main action is to reposition the uterus, then maintain it with internal bimanual compression. After the patient's perineum was sutured, the patient was observed for uterine contractions and given antibiotics. The patient had intermittent uterine contractions and bleeding therefore she was initiated to insert a condom catheter. The patient showed signs of improvement in her general condition and no active bleeding was found.Clinical discussionAn accurate diagnosis needs to be made early so that there is no misdiagnosis between uterine prolapse and uterine inversion. Good teamwork is needed in case management. It is necessary to approach both primary and tertiary health facilities for case screening and initial management.ConclusionCondom catheters can be helpful in the management of uterine inversion, particularly in stopping bleeding.

Evaluating the efficacy of bimanual compression of abdomen-flank to control postoperative bleeding after percutaneous nephrolithotomy: A randomized clinical trial.

To investigate the influence of bimanual compression of abdomen-flank to control bleeding after completion of percutaneous nephrolithotomy (PCNL) including tubeless PCNL. This study is a parallel-group randomized clinical trial with 1:1:1 randomization. Ninety patients who were candidates for PCNL during July to October 2019 were enrolled. After completion of PCNL operation, patients were randomized into three groups to receive bimanual abdomen-flank compression for 0, 3, and 7 min by the operating surgeon with the opening of sealed envelopes (groups 0, 3, and 7 min afterwards). Preoperative, 24, and 48 h postoperative hemoglobin (Hb) and electrolytes were collected. The primary endpoint of interest was the comparison of 48-h blood loss across study groups. Secondary endpoints included the percent drop in 24- and 48-h Hb, transfusion rates, and operation complications. This trial is registered at www.irct.ir with the following number: IRCT20190618043925N1 on 18 July 2019. There was no statistically significant difference in study groups regarding stone mass, stone location, access location, and patients' age (all p > 0.05). The medians (IQR) of 48-h blood loss were 490 mL (105-916), 338 mL (160-933), and 413 mL (71-650) in groups of 0, 3, and 7 min. The percent drop in 24-h postoperative Hb relative to preoperative Hb were 11.5 ± 8.6% versus 9.2 ± 7.3% versus 9.3 ± 6.8% (p = 0.44) and relative values for the percent drop in 48-h Hb relative to preoperative Hb were 8.6 ± 8.7% versus 9.5 ± 9.9% versus 7.2 ± 9.6% (p = 0.63) in groups of 0, 3, and 7 min respectively. Transfusion was needed in four patients in group 0 min, five patients in group 3 min, and three patients in group 7 min. The results of this study reveal that postoperative bimanual compression of abdomen-flank has no statistically significant influence on the control of bleeding after PCNL operations.

Comparison of the Effect of Three Different Methods in Reducing Primary Postpartum Hemorrhage

Objective: The aim of this study was to determine the effects of three different methods in reducing primary postpartum hemorrhage.Methods: The study was carried out in Istanbul/Turkey with 150 people at a maternity hospital. The participants were assigned to the external circular fundus massage (ECFM) (n=50), external bimanual fundus compression (EBFC) (n=50) and control (C) (n=50) groups with the simple randomization method. The women in the experiment groups of external circular fundus massage or external bimanual uterus fundus compression received intervention for one hour in the postpartum period. At the 6th postpartum hour, the hemogram values and total lochia amount of all women were measured.Results: The mean ± standard deviation (SD) age of the women was 24.77±4.40 years, 63.3% were having their first birth, and 47.3% gained weight between 11 and 16 kg in their pregnancy. There was no significant difference between the groups in terms of the mean ± SD Hb at the 6th postpartum hour (ECFM group=11.5±1.1; EBFC Group =11.7±3.6; C group =11.4±1.0 g /dL, F= 0.371, p = 0.691). In comparison to the ECFM and C groups, the 2nd postpartum hour visual analog scale (VAS) score of the EBFC group was found to be significantly lower (p<0.05).Conclusion: The hemoglobin and thrombocyte levels at the 6th postpartum hour were higher in the EBFC group in comparison to the other groups, while the hematocrit value decreased more. Since EBFC is effective in reducing postpartum pain, it is recommended to be applied especially to women with postpartum pain.

Control of Hemorrhage in Liver Trauma

Background: Control of hemorrhage in major liver trauma constitutes an ongoing surgical challenge even in nowadays, as surgeons often face difficult situations in its management. The goal of this study was to analyze our experience in the control of hemorrhage in major liver trauma. Materials and methods: Our study was performed prospectively covering a period of time from January 2009 till December 2012. 173 patients with liver trauma were included in our study. Results: Temporary haemostasis maneuvers in the setting of urgent laparotomy consisted of: bimanual compression 13 patients (15.3%), Pringle maneuver 23 patients (27%), perihepatic packing 10 patients (11,8%), Foley catheter balloon tamponade 2 patients (2.4%), intrahepatic tamponade in penetrating trauma 4 patients (4.7%). Definitive haemostasis methods used in urgent laparotomy were: electro-coagulation of the liver injury 12 patients (14.1%), haemostasis and biliostasis followed by hepatic closure 41 patients (48.2%), haemostasis and biliostasis without hepatic closure 6 patients (7.1%), tamponade with a pedicled vascularized omental flap (pedicled omentum hepatorrhaphy) 7 patients (8.2%), anatomic liver resection 1 patient (1.2%), nonanatomic/atypical liver resection 7 patients (8.2%), right hepatic artery ligation 1 patient (1.2%). Surgical techniques in preplanned laparotomies consisted of: left hepatectomy 1 patient (16.6%), right hepatectomy 1 patient (16,6%), nonanatomic/atypical liver resections 4 patients (66.7%). The success of treatment was significantly related to the grade of liver injury (z= 5.2912, p=<0.00001), other concomitant abdominal organ injuries (z=4.0743, p=0.00005), amount of blood transfusion received (p=0.03207), and age (p=0.04944). Overall mortality rate was 13%. Conclusion: Perihepatic packing and performing the surgical intervention in two sessions has significantly improved survival rates in major liver trauma from our experience.

Indocyanine-green fluorescence guided anatomical segmentectomy for HCC with portal thrombosis: the counter-fluorescence technique.

A surgical technique to intra-operatively define segmental boundaries by US-guided bimanual liver compression has been described by the authors, but this procedure is contraindicated in case of portal tumor thrombus. A technique to overcome this limitation is described. A patient with a single hepatocarcinoma nodule and segment 8 (S8) portal branch thrombosis was submitted to the procedure. Anatomical demarcation of S8 was achieved by hilar clamping of the common hepatic artery, intravenous injection of indocyanine green (ICG), and fluorescence imaging analyses of the liver. The procedure was feasible and the demarcation of S8 was visible within 2min from the iv injection of ICG in a counterstaining fashion. Then S8 segmentectomy was safely carried out. This novel approach seems feasible, providing a reliably anatomical and conservative removal of HCC with portal branch tumor thrombus.

Postpartum Hemorrhage: Use of Bakri Balloon During Cesarean Delivery, a Case Report and Review

The American College of Obstetricians and Gynecologists recently revised the definition of postpartum hemorrhage (PPH) to a cumulative blood loss of >= 1,000 mL (or) blood loss associated with signs or symptoms of hypovolemia within 24 h of the birth process. PPH is one leading cause of maternal mortality across the world. Prompt identification of the risk factors is proven to be helpful in earlier detection of PPH and is critical in preventing severe complications and related maternal morbidity and mortality. In this case report, we discuss a 29-year-old patient who had PPH at the time of cesarean delivery. This was effectively controlled by placement of an intraoperative Bakri balloon. The purpose of this review was to discuss and describe the indications and technique of Bakri balloon at the time of cesarean delivery complicated by PPH. Bakri balloon tamponade is usually indicated as a second-line treatment for severe PPH only when initial trials of bimanual compression of the uterus and uterotonic drugs fail to control bleeding. This appears to have minimal adverse effects on subsequent menstrual and reproductive function when intrauterine balloon tamponade is used for the management of severe PPH. Early use of intrauterine balloon tamponade is a way of effectively limiting ongoing uterine blood loss while initiating other measures, and can be readily implemented by providers with minimal training. Bakri balloon tamponade can be a life-saving intervention at the time of PPH and can reduce the need for a hysterectomy. J Clin Gynecol Obstet. 2019;8(2):57-61 doi: https://doi.org/10.14740/jcgo556

Interventions and Management of Postpartum Hemorrhage: A Literature Review

Bleeding is the main cause of maternal mortality in the world, the mortality rate due to bleeding about 30.3% in Indonesia in 2013. Dealing bleeding during and after labor is very important for health professionals including nurses. Research on the management of postpartum hemorrhage is still limited. The purpose of this literature review was to determine the management of postpartum hemorrhage from various countries. The method, this literature review involved articles that published in 2008-2018. The articles searched from several databases, including ProQuest, 32 articles, PubMed 22 articles, and Google 21 scholar articles. Keywords for article search included postpartum hemorrhage, nurse, prevention, treatment, management, and intervention. 75 articles were assessed for the quality using the JBI instrument (Joanna Briggs Institute), and finally, 10 articles were found and met the inclusion criteria. The results show that there are two types of actions to deal with postpartum hemorrhage including direct treatment and indirect treatment. The direct treatment includes bimanual compression, maneuvering techniques, balloon tampons, and tools resembling a butterfly shape for bimanual compression. Indirect actions include training of health workers, initiation of early breastfeeding and ice packs. Conclusion, effective management both directly and indirectly is able to overcome postpartum hemorrhage. Health workers are expected to master effective ways to deal with postpartum hemorrhage.

Manual volume delivery via Frova Intubating Introducer: a bench research study

Oxygen delivery through a Frova Intubating Introducer may be life-saving, and gas flow characteristics through this device have been described. Nevertheless, the feasibility of using a self-inflating resuscitation bag to deliver air or oxygen through this device has not been assessed. We compared volumes of air delivered and peak pressures generated with normal and maximal bimanual compression of a self-inflating resuscitation bag connected to a 70 cm Frova Intubating Introducer. In this bench research study, the proximal end of the 14-F Frova Intubating Introducer was connected to the self-inflating resuscitation bag, and the distal end was connected to a flow analyzer fitted with an adult test lung. Thirty-five anesthesia health care providers (staff/trainees) squeezed the self-inflating resuscitation bag with three normal and three maximal bimanual compressions. Endpoints of interest included the delivered volume of air and generated peak pressure. Normal bimanual compression resulted in a smaller mean (standard deviation) volume of air and peak pressure compared with maximal bimanual compression [554 (131) vs 955 mL (121); mean difference - 400.4; 95% confidence interval [CI], - 441.8 to - 359.0; P < 0.001; and 22.0 (3.4) vs 41.8 cmH2O (13.3); mean difference - 19.7; 95% CI, - 23.5 to - 15.9; P < 0.001, respectively]. Clinically useful, life-sustaining volumes of air can be delivered using normal and maximal bimanual compression of a self-inflating resuscitation bag connected to a 70 cm Frova Intubating Introducer. www.clinicaltrials.gov (NCT02786355); registered 27 January, 2016.

P116: A randomized cross-over trial of conventional bimanual versus single elbow (Koch) chest compression quality in a height-restricted aeromedical helicopter

Introduction: Aeromedical helicopters and fixed wing aircraft are used across Canada to transfer patients to definitive care. Given height limitation in aeromedical transport, CPR performance can be affected. An adapted manual compression technique has been proposed by H. Koch (pron. Cook) that uses the elbow to compress the sternum rather than the conventional hand. This preliminary study evaluated the quality of Koch compressions versus conventional bimanual compressions. Methods: Paramedics (5), registered nurses (3) and a physician (1) were recruited. Each participant performed a 2 minute cycle of each technique, were randomized to determine which technique was performed first, and rested 5 minutes between compression cycles. A Resusci Anne SkillReporter manikin atop a stretcher in a BK117 helicopter was used. The compressors performed without feedback or prompting. Outcomes include compression rate, depth, recoil, and fatigue. Results: The mean conventional compression rate was (bpm) 118 +/− 13 versus 111 +/− 10 in the Koch scenario (p=0.02) (target 100 to 120). Mean conventional compression depth (mm) was 44 +/− 9 versus 49 +/− 7 in the Koch scenario (p=0.01) (target 50 to 60). The mean percentage of compressions with complete release in the conventional scenario was 86 +/− 20 versus 84 +/− 22 in the Koch scenario (p=0.9) (target 100%). Using a Modified Borg Scale of 1 to 10, mean provider fatigue after conventional CPR was 7 (+/− 1.6) versus 3 (+/− 1.2) using Koch technique (p&lt;0.001). On average, Koch technique improved the percentage of compressions at target rate by 26%, the percentage at correct depth by 9%, overall compression quality score by 13% and were more less fatiguing. Conclusion: Using an elbow in a height-restricted environment improved compression depth and reduced provider fatigue. From our limited data, Koch compressions appear to improve compression quality. Further study and external validation are required.

P032: Twelve angry medics: a study of bimanual external aortic compression in healthy adult men

Introduction: Following life-threatening hemorrhage the goal is to temporize blood-loss and expedite definitive-rescue. Junctional (abdominal-pelvic) trauma, between the inguinal ligament and umbilicus; is a leading cause of potentially survivable mortality. Numerous devices such as junctional tourniquets and resuscitative endovascular balloon occlusion of the aorta have been suggested for this injury pattern, but we propose an immediately available and expedient bimanual maneuver that may act as a bridge to device application, proximal external aortic compression (PEAC). Of note, external aortic compression has been used for centuries in life-threatening postpartum hemorrhage. Methods: Twelve paramedic volunteers were recruited from a continuing education event. Participant demographics, blood pressure, abdominal circumference, body mass index and procedural discomfort were recorded. In pairs, six participants were taught PEAC and performed the maneuver, then exchanged roles. Training consisted of researcher led demonstration and participant return demonstration with feedback. The duration of training was less than five minutes for all participants. Femoral artery hemostasis was measured by doppler ultrasound. Results: Participant mean age was 28.6 (range 22 to 46) and their mean systolic blood pressure was 128.25 mmHg (range 102 to 145). Mean body mass index was 24 (range 22 to 28) and abdominal girth was 80 cm (range 70 to 110). Bilateral common femoral artery blood flow became undetectable in all participants, by doppler ultrasound. Participant discomfort was reported as a mean of 4.4 (range 3 to 6) on a zero to ten scale. No complications were reported with seven and 30 days follow-up. Conclusion: This study demonstrates successful PEAC in twelve healthy participants. However, our limitations include a small sample and the relatively modest abdominal circumferences of our participants. If light of these limitations, PEAC may be a potentially life-saving maneuver which is immediately deployable and easy to learn, for patient temporization until device application and/or operative rescue.

Percutaneous K-Wires Fixation of Displaced Intra-articular Calcaneal Fractures (A Novel Technique)

Category: Hindfoot Introduction/Purpose: The operative treatment of calcaneal fractures has been a controversial topic. Open reduction and internal fixation is associated with a high incidence of postoperative soft tissue complications. Closed reduction and percutaneous K-wires fixation was used to preserve soft tissue. The aim of our study is to evaluate the outcome of closed reduction and percutaneous K-wires fixation of displaced intra-articular calcaneal fractures. Methods: Twenty two displaced intra-articular calcaneal fractures were treated by closed reduction and percutaneous K-wires fixation. The clinical evaluation was based on Maryland Foot Score. According to Sander’s Classification, Eleven fractures were type II, nine were type III and two were type IV. Bimanual compression across the calcaneus was applied to reduce the calcaneal width. A Schanz screw was inserted into the calcaneal tuberosity and was forcibly pushed downwards to elevate the depressed fragment. Two parallel 2 mm K-wires were placed from the posterior inferior corner of the calcaneus across the posterior facet and into the talar body. The reduction of the articular surface was maintained by two crossing subchondral 2 mm K-wires. If the reduction was not satisfactory, a 1-2 cm long transverse incision was used just below the tip of the lateral malleolus. A small tipped periosteal elevator was introduced to elevate the depressed fragment before K-wire fixation. Results: The mean follow up period was 7.68 months. The clinical outcome revealed 18 fractures (81.8%) of satisfactory (14 excellent and 4 good), and 4 patients (18.2%) of unsatisfactory results (4 fair and 0 poor). The mean time of radiological union was 11.86 (range 10 – 14) weeks. One patient had pin tract infection. One patient developed heel widening. Conclusion: Closed reduction and percutaneous K-wires fixation of calcaneal fractures minimizes the soft tissue complications and postoperative scar formation. The mini approach for elevation of the depressed posterior facet restores the articular surface and decreases late subtalar arthritis.

PPH Butterfly: a novel device to treat postpartum haemorrhage through uterine compression

ObjectivePostpartum haemorrhage (PPH) is a significant cause of maternal morbidity and mortality. The most common cause is an inability of the uterus to contract adequately after childbirth. In bimanual compression...

A Model Practice Template for Hydrotherapy in Labor and Birth.

A Model Practice Template for Hydrotherapy in Labor and Birth.

Management of postpartum hemorrhage with intrauterine balloon tamponade using a condom catheter in an Egyptian setting

ObjectiveTo evaluate uterine balloon tamponade using a condom catheter for the management of early postpartum hemorrhage (PPH). MethodsIn a prospective observational study at Menoufia University Hospital, Shebin Elkom, Egypt, women with early PPH were enrolled between May 2011 and September 2012. Uterine balloon tamponade with a condom catheter was applied in women who were unresponsive to uterotonics and bimanual compression; patients with successful catheter placement were included in analyses. The primary outcome was successful control (reduction or cessation) of bleeding. ResultsA condom catheter was successfully placed for 50 of the 151 women enrolled. The overall success rate of the procedure was 96% (48/50). The condom catheter was successful in all 28 cases of atonic PPH after vaginal or cesarean delivery. It successfully controlled PPH due placental site bleeding in 20 (91%) of 22 patients with placenta previa and a well-contracted uterus. ConclusionCondom balloon catheter was found to effectively control PPH. The procedure is simple, inexpensive, and safe, and can preserve reproductive capacity, as well as saving the life of the mother.ClinicalTrials.gov:NCT02672891.

TANDA BAHAYA SERTA PENATALAKSANAAN PERDARAHAN POST-PARTUM

Post-partum hemorrhage defined by WHO by condition loss of blood &gt;500 ml of 24 hours after labor. Based on research in 2008, said every women that died in minute on labor, that 24% caused by massive hemorrhage. Diagnosis of post-partum hemorrhage acquired by seeking the cause of hemorrhage, calculate the blood loss and patient clinical condition. Treatment of post partum hemorrhage started by giving uterotonic, uterine massage, bimanual compression, blood transfusion/ crystalloid fluid, giving blood coagulation factor, and/or retain rest placenta manually and trauma management. Invasive treatment such are balloon tamponade, uterine compressed hecting, angiographic arterial embolization, arterial ligation, and hysterectomy. Some modified technic also very suggested to be able to performed in area with limited facilities. Prevention of post-partum hemorrhage are by perform management active phase III, knowing the risk factor and always do consultation with competent medical staff.

Intrauterine balloon catheter in the management of postpartum hemorrhage

Objective The aim of this study was to evaluate the outcome of uterine balloon tamponade using a condom-catheter in the management of primary postpartum hemorrhage (PPH). Background Guidelines for the management of postpartum hemorrhage involve a stepwise approach including the exclusion of retained products and genital tract trauma. Uterine atony, which is the most common cause, is dealt with uterine rubbing and various uterotonic agents. Among the new modalities introduced to arrest the bleeding is the uterine tamponade using various balloons and catheters. The condom catheter uses a sterile rubber catheter fitted with a condom that can be used for uterine tamponade. Materials and methods This prospective observational study included 50 women with PPH unresponsive to uterotonics and bimanual compression, and was conducted at the Department of Obstetrics and Gynecology, Menoufia University Hospital, Egypt. About 28 patients suffered from atonic postpartum hemorrhage, whereas 22 patients suffered from PPH due to placenta previa. Clinical assessment, laboratory investigations, and intrauterine condom catheter were applied to all patients. The primary outcome was the success of the balloon to stop bleeding; however, maternal complications were assessed as the secondary outcome. Results The condom catheter was successful in controlling PPH in all cases of atonic PPH (28/28; 100%): 18 after vaginal delivery and 10 after cesarean section. It successfully controlled PPH due to placental site bleeding in 20 cases (90%) and failed to control PPH in two cases (10%), which were managed by cesarean hysterectomy. There was (P Conclusion The condom catheter controls PPH effectively. It is a simple, inexpensive, and safe method of conserving the reproductive capacity along with saving the life of women with primary PPH.