Intrauterine Balloon Tamponade Research Articles

Comparison of Efficacy and Safety of Intrauterine Balloon Tamponade Versus Uterovaginal Packing in Females Presenting with Postpartum Hemorrhage after Normal Vaginal Delivery

To compare the efficacy and safety of intrauterine balloon tamponade with uterovaginal roll gauze packing in patients presenting with primary postpartum hemorrhage after normal vaginal delivery. This randomized controlled trial, conducted at Department of Obstetrics and Gynecology, Lady Willingdon Hospital, Lahore, from December 2015 to November 2016. Two hundred and twelve patients presenting with primary postpartum hemorrhage who did not respond to medical treatment following normal vaginal delivery were included. They were randomly divided in two groups. The first group underwent balloon tamponade using condom and second group underwent intrauterine packing using roll gauze. Both interventions were removed after 24 hours. All females were kept under observation with antibiotic coverage in ward to prevent infection. If bleeding was stopped within 15 minutes and the patient remained hemodynamically stable, then efficacy was labeled and if no complications occur while applying or removing, safety was labeled. Mean age group of women using balloon tamponade and intrauterine packing was used was 28.25±4.672 and 28.30±4.613 years. The mean gestational age of patients using balloon tamponade and intrauterine packing was 38.57±1.36 and 38.63±0.62 years. Mean blood loss in patients using balloon tamponade and intrauterine packing was 600.28±25.338 and 699.21±70.176 ml. Efficacy of intrauterine packing was 94 (88.7%) and balloon tamponade was 104 (98.1%). Safety of intrauterine packing was 83 (78.3%) and that of balloon tamponade was 97 (91.5%). Thus, treatment of balloon tamponade was more effective and safer than intrauterine packing in female presenting with postpartum hemorrhage after normal vaginal delivery.

Uterine Balloon Tamponade in Management of Postpartum Hemorrhage

Aim. To evaluate the efficacy and safety of uterine balloon tamponade for the management of postpartum haemorrhage.Materials and Methods. We have screened the Cochrane Library and PubMed for the following keywords: “intrauterine balloon tamponade”, “controlled balloon tamponade”, “controlled balloon tamponade” AND “postpartum bleeding/haemorrhage” during 5 years (2018-2023). In total, we have identified 358 publications including 3 meta-analyses, 6 systematic reviews, and 13 randomized controlled trials. After checking titles and abstracts to remove duplicates, we selected 38 sources which met the selection criteria.Results. Postpartum haemorrhage remains the leading cause of maternal mortality in both developing and developed countries. In most cases, postpartum haemorrhage occurs due to atony and is controlled by administration of uterotonics. However, if uncurbed, postpartum haemorrhage requires blood transfusion and surgery. Currently, uterine balloon tamponade is considered as one of the most efficient and safe technologies for controlling postpartum haemorrhage and preventing hysterectomy, yet a number of studies have reported negative results. Several investigations showed an advantage of double-balloon tamponade as it provides an additional benefit of vascular compression of the lower uterine segment. Generally, uterine balloon tamponade is an efficient intervention which allows to avoid additional surgeries (uterine artery embolization or hysterectomy) in 87.3 – 100.0% of cases with a relatively low complication rate (< 6.7% – 9.4%).Conclusion. The effectiveness of uterine balloon tamponade and the risk of complications are probably determined by the type of device, the learning curve effect, and the regularity and quality of training of medical personnel. Further in-depth multicenter studies in this direction are required.

Peut-on prévenir l’échec du ballon de tamponnement intra-utérin selon la voie d’accouchement ?

ObjectiveThe intrauterine balloon tamponade (IUBT) is one of the major tool to manage the postpartum hemorrhage (PPH). Previous studies identified factors predicting IUBT failure regardless the mode of delivery. Our aim was to determine if IUBT predictive failure can be determined regarding the mode of delivery. Materials and methodsThis was a retrospective cohort study among women who had IUBT secondary to severe PPH after vaginal or cesarean delivery from 2012 until 2021 at Lille (France). We compared 2 groups: success or failure of the IUBT, which was defined as the need of additional invasive procedures (uterine embolization or surgical procedure). ResultsWe included 238 women, 83 who underwent cesarean and 155 vaginal delivery. The overall success of the IUBT was 78% (80% for vaginal delivery and 75% for cesarean delivery). In the vaginal delivery group with failed IUBT, coagulopathies were significantly more frequent (84.2 vs. 33.3% P=<0.001) with higher estimated blood loss at the use of the IUBT (1865.8 vs. 1580.8mL, P=0.015) compared with the vaginal delivery group with success of IUBT. In the cesarean delivery group, none factor was significant between the two groups. ConclusionIt is possible to identify predictors of IUBT failure in case of vaginal delivery. In contrast, in case of cesarean delivery, there is no apparent predictive facto. It could be interesting to validate our findings in a multicentric study.

Timely use of Bakri intrauterine balloon tamponade contributes to the effectiveness in controlling severe postpartum hemorrhage.

The aim of the present study was to explore the effectiveness of Bakri intrauterine balloon tamponade (IUBT) in treating severe postpartum hemorrhage (SPPH). A cohort of 198 women with SPPH using IUBT were retrospectively selected. The baseline and maternal outcome characteristics were examined. The results demonstrated that women with SPPH had a high proportion of placenta accrete (53.0%). Bakri IUBT demonstrated a global effectiveness of 84.5% in SPPH treatment, accounting for 82.9% in women with placenta accrete. Compared with women with Bakri failure, women who experienced Bakri success had reduced rates of less use of pre-/post-IUBT intervention, blood transfusion, lower genital tract trauma, estimated blood loss (EBL), and a longer indwelling duration (P<0.05). Logistic regression revealed that the pre-IUBT intervention (OR=3.910; 95% CI: 1.684-9.079; P=0.002) was positively associated with hemostasis success, while lower genital tract trauma was negatively associated with Bakri success (OR=0.091; 95% CI: 0.009-0.894; P=0.040). Moreover, women diagnosed with placenta accrete underwent a greater number of transabdominal placed Bakri IUBT and pre-IUBT interventions than those without placenta accrete (P<0.05). No significant differences were observed in Bakri success, total EBL, pre-/post-IUBT EBL, infused volume of IUBT, IUBT indwelling duration, even the rate of hemostasis, lower genital tract trauma, blood transfusion, post-IUBT intervention, and puerperal fever between women with and without placenta accrete (P>0.05). In conclusion, placenta accrete may be the leading cause of SPPH. Bakri IUBT is an effective and safe measure for SPPH. Pre-IUBT intervention may be predictive of Bakri's success. The timely use of IUBT during labor may mitigate the impact of risk factors identified on PPH.

Efficacy of Bakri Intrauterine Balloon in Managing Postpartum Hemorrhage: A Comparative Analysis of Vaginal and Cesarean Deliveries with Placenta Accreta Spectrum Disorders.

BACKGROUND The incidence of placenta accreta spectrum disorder (PAS) has been increasing in past decades, and women with PAS are a high-risk maternal population. This study aimed to explore the performance of Bakri intrauterine balloon tamponade (IUBT) in the treatment of postpartum hemorrhage (PPH), among those with and without PAS. MATERIAL AND METHODS The outcomes of 198 women who underwent treatment for PPH using IUBT were retrospectively analyzed. The demographics and maternal outcomes were analyzed for vaginal and cesarean births, with PAS and without PAS. RESULTS Compared to women with vaginal births (n=130), women who underwent cesarean births (n=68) showed a higher proportion of age ≥35 years (χ²=6.85, P=0.013), multiple births (χ²=13.60, P<0.001), preeclampsia (χ²=9.81, P=0.002), use of transabdominal IUBT (χ²=84.12, P<0.001) and pre-IUBT interventions (χ²=41.61, P<0.001), but had less infused volume of physiological saline (t=6.41, P<0.001). Women with PAS (n=105) showed a higher rate of pre-IUBT intervention (χ²=4.96, P=0.029) and transabdominal IUBT placement (χ²=9.37, P=0.002) than non-PAS women (n=93). The 36 women with PAS (n=36) showed a higher rate of preeclampsia (χ²=4.80, P=0.029), pre-IUBT intervention (χ²=5.90, P=0.015), and transabdominal IUBT placement (χ²=14.94, P<0.001) and a shorter duration from delivery to Bakri insertion (χ²=3.31, P=0.002), than non-PAS women (n=32). CONCLUSIONS PAS was a major cause of PPH at 198 vaginal and cesarean births. An accurate and timely pre-IUBT intervention and Bakri IUBT placement was critical for controlling PPH in cesarean births, especially in women with PAS.

Intrauterine Postpartum Hemorrhage-Control Devices.

Postpartum hemorrhage , defined as a cumulative blood loss of 1,000 mL or more or blood loss associated with signs or symptoms of hypovolemia regardless of the route of delivery, is the leading cause of preventable maternal death worldwide. The United States has one of the highest maternal mortality rates among developed countries, with about 14% of all maternal deaths associated with postpartum hemorrhage. Although postpartum hemorrhage has multiple causes, the most common is uterine atony-when the uterus fails to adequately contract after childbirth-accounting for 80% of all postpartum hemorrhages. When postpartum hemorrhage occurs despite preventive measures, therapeutic measures are used. Intrauterine hemorrhage-control devices are often the second-line therapy when medical management is unsuccessful. Despite its widespread use in current obstetric practice, the mechanism of intrauterine balloon tamponade, such as the Bakri balloon, is counterintuitive to the physiologic uterine contraction that occurs after delivery to control bleeding, and data on its effectiveness are mixed. Vacuum-induced hemorrhage control, such as with the Jada System, cleared by the U.S. Food and Drug Administration in 2020, is a novel modality for control of postpartum bleeding. It mimics postpartum physiology by applying low-level intrauterine negative pressure to facilitate uterine compressive forces, thereby constricting blood vessels to achieve hemostasis. Preliminary data from four studies are promising but are limited by a lack of control groups, selection bias, or modest sample sizes. The results of ongoing and planned randomized controlled trials will clarify the role of the Jada System for reducing morbidity from postpartum hemorrhage.

Investigation of the usefulness of intrauterine balloon tamponade after manual placental removal

Investigation of the usefulness of intrauterine balloon tamponade after manual placental removal

Intrauterine Tamponade Balloon for Management of Severe Postpartum Haemorrhage: Does Early Insertion Change the Outcome? A Retrospective Study on Blood Loss.

To evaluate the role of the timing of IUTB insertion and to assess the correlation between the time of insertion and outcome. A retrospective study in two tertiary care centres, including patients transferred for severe PPH management. A total of 81 patients were included: 52 patients with IUTB inserted before 15 min (group 1) and 29 patients with IUTB inserted after 15 min (group 2). The mean volume of blood loss in the group of patients with IUTB inserted before 15 min was significantly lower than in group of patients with IUTB set after 15 min. An IUTB could be inserted simultaneously with a uterotonic agent, within 15 min and not after 15 min as suggested by local guidelines, but further prospective studies are required to confirm this.

Efficacy of Balloon Tamponade in Postpartum Hemorrhage

Aim: An estimated loss of more than 500 mL of blood after vaginal delivery and more than 1000 mL of blood following caesarean delivery from the birth canal within 24 hours is considered primary postpartum haemorrhage (PPH). Rightfully termed the "obstetrician's nightmare," primary postpartum haemorrhage remains a major contributor to maternal mortality and morbidity in underdeveloped countries like Pakistan, where it accounts for 21-31% of maternal deaths. As a result, investigating PPH management strategies is vital. Objectives: To determine the efficacy of intrauterine balloon tamponade in the management of post-partum hemorrhage Study Design: Descriptive study Study Setting: Department of Obstetrics and Gynecology, Sheikh Zayed Medical from 21st May 2021 till 20th November 2021. Methods: Total 126 women aged 18-35 years, parity 1-6 and 31-41 weeks of gestation, who develop atonic post-partum hemorrhage not responding to uterotonics following normal vaginal delivery or caesarean section were enrolled using non-probability consecutive sampling technique. Women having postpartum hemorrhage were treated with balloon tamponade to stop bleeding. Efficacy was noted after 06 hours of procedure. Data was entered and analyzed using SPSS 25. Results: In this study total 126 patients were enrolled with mean age of 25.6±5.3 years. Mean gestational age was 38.2±3.2 weeks. Mean blood loss was 1032.1±379.6 ml. Mean parity was4.1±1.3. Most of patients had middle education i.e. 33.3%. Majority of patients belonged to middle socioeconomic status i.e. 47.6%. There were 41.3% patients who were booked and 2 had regular antenatal visits. Vaginal delivery was done in 55.6% patients. Balloon tamponade was effective in 81% patients. Practical Implication: Since balloon tamponade is a relatively new procedure, there is little information about its efficacy compared to the more traditional method of uterovaginal packing in Pakistan. Conclusion: Balloon tamponade is effective in stopping postpartum hemorrhage. The success rate (81%) of balloon tamponade in preventing PPH is high. It's convenient for use in situations with a higher risk of PPH. Keywords: Postpartum Hemorrhage, Balloon Tamponade, Delivery, Efficacy, Blood Loss, Management

Antibiotic Recommendations After Postpartum Uterine Exploration or Instrumentation.

Multiple postpartum scenarios require uterine exploration or instrumentation. These may introduce bacteria into the uterus, increasing the risk of endometritis. Data on the use of antibiotics in these scenarios is limited, resulting in few guidelines and divergent care. To describe postpartum scenarios requiring uterine exploration and/or instrumentation, review data on antibiotic prophylaxis, and delineate antibiotic recommendations for each scenario. Original articles were obtained from literature search in PubMed, MEDLINE, and OVID; pertinent articles were reviewed. These recommendations are based on published evidence and professional society guidelines. Antibiotic prophylaxis following manual placenta removal should include 1-time combination of ampicillin 2 g intravenously (IV) or cefazolin 1 g IV, plus metronidazole 500 mg IV. Antibiotic prophylaxis before postpartum dilation and curettage, manual vacuum aspiration, and intrauterine balloon tamponade should include 1-time combination of ampicillin 2 g IV plus metronidazole 500 mg IV. If the patient in any of the above scenarios has received group B Streptococcus prophylaxis, then only metronidazole is recommended. Further randomized clinical trials are needed to optimize these regimens. Uterine exploration or instrumentation increases the risk of postpartum endometritis and requires antibiotic prophylaxis. For manual placenta removal, we recommend 1-time combination of ampicillin 2 g IV or cefazolin 1 g IV, plus metronidazole 500 mg IV. For dilation and curettage, manual vacuum aspiration, and intrauterine balloon tamponade, we recommend 1-time combination of ampicillin 2 g IV plus metronidazole 500 mg IV. For patients who already received antibiotic prophylaxis for group B Streptococcus, we recommend 1-time dose of metronidazole 500 mg IV. Providers can utilize our guidelines to prevent postpartum endometritis in these scenarios requiring postpartum uterine exploration and/or instrumentation.

Efficacy of early intrauterine balloon tamponade for immediate postpartum hemorrhage after vaginal delivery: a randomized clinical trial

Many questions remain about the appropriate use of intrauterine balloon devices in postpartum hemorrhage after vaginal delivery refractory to first-line uterotonics. Available data suggest that early use of intrauterine balloon tamponade might be beneficial. This study aimed to compare the effect of intrauterine balloon tamponade used in combination with second-line uterotonics vs intrauterine balloon tamponade used after the failure of second-line uterotonic treatment on the rate of severe postpartum hemorrhage in women with postpartum hemorrhage after vaginal delivery refractory to first-line uterotonics. This multicenter, randomized, controlled, parallel-group, nonblinded trial was conducted at 18 hospitals and enrolled 403 women who had just given birth vaginally at 35 to 42 weeks of gestation. The inclusion criteria were a postpartum hemorrhage refractory to first-line uterotonics (oxytocin) and requiring a second-line uterotonic treatment with sulprostone (E1 prostaglandin). In the study group, the sulprostone infusion was combined with intrauterine tamponade by an ebb balloon performed within 15 minutes of randomization. In the control group, the sulprostone infusion was started alone within 15 minutes of randomization, and if bleeding persisted 30 minutes after the start of sulprostone infusion, intrauterine tamponade using the ebb balloon was performed. In both groups, if the bleeding persisted 30 minutes after the insertion of the balloon, an emergency radiological or surgical invasive procedure was performed. The primary outcome was the proportion of women who either received ≥3 units of packed red blood cells or had a calculated peripartum blood loss of >1000 mL. The prespecified secondary outcomes were the proportions of women who had a calculated blood loss of ≥1500 mL, any transfusion, an invasive procedure and women who were transferred to the intensive care unit. The analysis of the primary outcome with the triangular test was performed sequentially throughout the trial period. At the eighth interim analysis, the independent data monitoring committee concluded that the incidence of the primary outcome did not differ between the 2 groups and stopped inclusions. After 11 women were excluded because they met an exclusion criterion or withdrew their consent, 199 and 193 women remained in the study and control groups, respectively, for the intention-to-treat analysis. The women's baseline characteristics were similar in both groups. Peripartum hematocrit level change, which was needed for the calculation of the primary outcome, was missing for 4 women in the study group and 2 women in the control group. The primary outcome occurred in 131 of 195 women (67.2%) in the study group and 142 of 191 women (74.3%) in the control group (risk ratio, 0.90; 95% confidence interval, 0.79-1.03). The groups did not differ substantially for rates of calculated peripartum blood loss pf ≥1500 mL, any transfusion, invasive procedure, and admission to an intensive care unit. Endometritis occurred in 5 women (2.7%) in the study group and none in the control group (P=.06). The early use of intrauterine balloon tamponade did not reduce the incidence of severe postpartum hemorrhage compared with its use after the failure of second-line uterotonic treatment and before recourse to invasive procedures.

Effectiveness of Foleys Intrauterine Balloon Tamponade in Management of Postpartum Haemorrhage and Factors Associated With its Failure; A Tertiary Care Experience

OBJECTIVES To evaluate the effectiveness and factors associated with the failure of intrauterine balloon tamponade (IUBT) in managing postpartum hemorrhage (PPH). METHODOLOGY We conducted a retrospective observational study including data from 160 patients aged 21-30 years at the Department of Obstetrics and Gynaecology, Lady Reading Hospital, Peshawar, managed for PPH with IUBT, after failed medical treatment from Jan 2020 to December 2021. Data were collected retrospectively in three months, from January to March 2022. IUBT was successful if, after 24 hours of insertion, no or less than 100ml bleeding occurred.RESULTS Among the patients managed by IUBT, the majority had uterine atony (81.25%), 17.5% had lower segment hemorrhage, and 1.25% of cases had a placental abruption. The mean estimated blood loss was 1263.7±398.7 ml. The procedure was successful in 89.3% of cases. Sixteen patients underwent a hysterectomy for failed IUBT. There were six maternal deaths, mainly due to acute renal failure and disseminated intravascular coagulation (DIC). Between the successful and unsuccessful cases of IUBT, there was a statistically significant difference in the gravidity, mode of delivery, gestations, booking, peripartum BP, pulse rate, hemoglobin, platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), blood loss during the procedure, DIC, and intensive care unit admissions (p&lt;0.00). The median hemoglobin, hematocrit, platelets count, and lymphocytes were significantly higher before IUBT insertion (p&lt;0.00).CONCLUSION IUBT is an effective, easy-to-use, inexpensive, and safe tool in the management of PPH. Low hemoglobin, thrombocytopenia, high PT, aPTT, and DIC are associated with low success rates

ROLE OF INNOVATIVE BALLOON TAMPONADE IN ATONIC POST PARTUM HAEMORRHAGE

Introduction: Postpartum hemorrhage is the major cause of maternal deaths, especially in the developing world. Uterine atony is the most common cause of PPH and when the hemorrhage is not controlled with medical management then Intrauterine balloon tamponade is one method that proves very effective and reduces the need for further surgical interventions. T Aims &amp; Objectives: o evaluate the effectiveness of balloon tamponade in the management of atonic PPH. This prospective study was conducte Materials &amp; Methods: d in the Department of Obstetrics &amp; Gynaecology at Government Medical College and Rajendra Hospital, Patiala. We included 50 cases of atonic PPH in the study where medical management failed. Uterine tamponade was achieved by an innovative condom balloon catheter The success rate of balloon tamponade Results: in controlling bleeding came out to be 94%. We concluded that Uterine balloon tam Conclusions: ponade is effective, non-invasive, simple to use, easily available, and cost-effective method for the management of PPH. If we are unable to control bleeding with this method, it provides a temporary tamponade effect to gain time for surgical procedures or referral to a higher center if facilities are not available

Efficacy of Intrauterine Balloon Tamponade by 24-French Foley Catheter in Prevention of Postpartum Hemorrhage

Efficacy of Intrauterine Balloon Tamponade by 24-French Foley Catheter in Prevention of Postpartum Hemorrhage

Effectiveness of intrauterine condom tamponade in atonic postpartum hemorrhage

Introduction: Postpartum hemorrhage(PPH) is the leading cause of maternal mortality. The intrauterine balloon tamponade is the efficient and economical means to treat atonic PPH so this study was done to evaluate the outcome of uterine balloon tamponade in atonic PPH.&#x0D;  &#x0D; Method: This was a retrospective study conducted at the Patan Academy of Health Sciences Lalitpur, Kathmandu from January 2017 to December 2019. It included women with postpartum haemorrhage due to uterine atony in whom medical treatment had failed. &#x0D;  &#x0D; Result: The condom tamponade was successful in 94.7% women with uterine atony, who did not respond to uterotonic drugs and 5.3% required peripartum hysterectomy. Majority of women were in the 25-29 years age group. 73.3% were multigravida and 63.2% had vaginal delivery. No case of febrile morbidity and wound sepsis was noted.&#x0D;  &#x0D; Conclusion: The study concludes the use of condom tamponade as an effective means of controlling atonic PPH. It is safe, easily available, inexpensive, minimally invasive, does not require anesthesia, easy to use and can be performed by any level of health personnel with some training.&#x0D;  

Safety and efficacy of intrauterine balloon tamponade vs uterine gauze packing in managing postpartum hemorrhage: A systematic review and meta-analysis

BACKGROUNDThere is debate on whether uterine gauze packing or intrauterine balloon tamponade is safer and more effective as a surgical management option for treating postpartum hemorrhage. OBJECTIVEThis study aimed to compare intra- and postoperative outcomes of intrauterine balloon tamponade and uterine gauze packing in patients with postpartum hemorrhage. STUDY DESIGNA range of databases such as Cochrane and PubMed were searched using terms including “post-partum haemorrhage,” “uterine balloon tamponade,” and “uterine gauze packing.” All observational studies comparing intrauterine balloon tamponade with uterine gauze packing were included. Five studies were identified enrolling 821 adult patients diagnosed with postpartum hemorrhage. Primary outcomes included blood loss volume, success rates, and maternal mortality. Secondary outcomes comprised requiring additional interventions, postoperative hemoglobin levels, and requiring blood transfusions. Fixed and random models were used for analysis. RESULTSIntrauterine balloon tamponade seemed to be a superior option to uterine gauze packing. Intrauterine balloon tamponade was better in reducing intraoperative blood loss, with a statistically significant improvement (P<.0001). Cases managed with intrauterine balloon tamponade seemed to have statistically significant shorter operative time (P=.023) and hospital length of stay (P=.020) in one study. CONCLUSIONIntrauterine balloon tamponade remains more effective and safer as a first-line surgical management option for postpartum hemorrhage compared with uterine gauze packing.

Efficacy of Follys Catheter Intrauterine Balloon Temponade for the Control of Postpartum Hemorrhage

Objective: This research aims to determine how well balloon temponade works as a treatment for postpartum bleeding. Study Design: Retrospective Study Place and Duration: Gynaecology and Obstetrics Department, Combined Military Hospital, Peshawar for the duration from February 2021 to January 2022. Methods: Total 118 women had age 18-40 years were presented in this study. Patients who were diagnosed with, or who were admitted to the hospital for treatment of primary postpartum haemorrhage caused by uterine atony were included. Gestational age and parity among all females were recorded. Folly catheter intrauterine ballon tamponade was used and its effectiveness among all cases was assessed. SPSS 23.0 was used to analyze all data. Results: Among 118 cases, 40 (33.9%) cases had age 18-25 years, 55 (46.6%) females had age 26-30 years and 23 (19.8%) cases had age &gt;30years. 75 (63.6%) had BMI &lt;25kg/m2 and 43 (36.4%) had BMI &gt;25kg/m2. Mean gestational age of the females was 36.55±6.72 and mean parity was 3.11±6.9. Mean blood loss was 1208.5±227.9 ml. Mean pulse rate was 106.8±4.97 bpm. Mean systolic and diastolic blood pressure was 88.41±12.7 mmHg and 56.14±8.4 mmHg. Efficacy of balloon tamponade was found in 108 (91.5%) cases. Complications were found in 3 (3.5%) cases. Conclusion: We conclude that follys intrauterine catheter balloon tamponade controls postpartum bleeding. There should be a low threshold for using balloon tamponade as it is effective, easy to use, easily available, has a low complication rate, and is an economical modality to control non-traumatic postpartum haemorrhage, especially in resource-limited settings, and sustain reproductive potential. Keywords: Balloon Temponade, PostPartum Haemorrhage, Efficacy, Complications

Evaluation of Retained Placenta: A Study in a District Hospital

Introduction: The placenta is an organ that is attached to the uterine wall and connects the fetus with the mother through the umbilical cord. The placenta is said to be retained when it is not expelled out even half an hour after the birth of the baby. The study aimed to evaluate the retention of the placenta. Methods: This was a cross-sectional study was conducted at the Department of Obstetrics &amp; Gynecology , Faridpur Medical College Hospital, Faridpur from June 2016 to November 2016. The sample was taken purposively and the sample size was 110. Patients were diagnosed with a case of 'retained placenta' through proper history, and clinical examination. Written informed consent was taken from every patient or their relatives. The information was collected in a preformed data collection sheet. Observation and results of the study and statistical analysis were presented in tables. Data were analyzed by using the computer-based program Statistical Package for Social Science (SPSS) software for windows. Result: Out of 110 study subjects about 58.18% were found in the age group of 21-30 years and 20% were found in the age group of 20 years. The age of the patients ranges from 18 to 40 years. Among 110 study subjects, 64.55% were from lower socioeconomic status, 27.27% were from middle socioeconomic status and only 8.18% belonged to affluent socioeconomic status. The majority (74.54%) of cases were delivered at home and 25.46% of cases were delivered at different levels of hospitals (among them 1.82% of cases occurred in the institute where the study was done). Among them 20% were para- 1, 54.54% were para-2-4 and 25.46% of respondents were para ≥ 5. The majority (60%) of study subjects were admitted between 3 to 8 hours after developing retained placenta, followed by 18.19% who came within 2 hours. Regarding the clinical presentation, 69.09% of study subjects presented with anemia of varying degrees, 24.53% presented with shock, 5.45% presented with sepsis, and only 0.93% (one patient) presented with acute renal failure. Concerning predisposing factors of retained placenta, 25.46% of study subjects were grand multipara, 11.82% had H/O MR or D &amp; C, 10.90% with prolonged labor, 10.90% respondents had IUD, 10% with past H/O retained placenta, 8.20% had preterm labor, 2.72% had H/O LUCS/ other uterine surgery and 20% were without any predisposing factors. Among the respondents, 27.27% of study subjects presented with genital tract trauma, 5.45% with sepsis, 5.45% with acute renal failure, 0.91% with DIC, 0.91% with uterine prolapse 64.55% with no associated conditions/complications. Among the total study population, 58.18% of retained placenta cases required manual removal under G/A, and 41.82% were managed by manual removal of the placenta under deep sedation. Out of 110 respondents, 21.82% of cases of retained placenta did not require any blood transfusion, 58.18% received 1-2 units and 20% received 3 or more units of blood transfusion. During management, 13.63% of study subjects developed uterine atony, 0.91% developed uterine inversion, 2.73% were complicated by uterine perforation, 0.91% were complicated by anesthetic hazard; 81.82% had no complication during management. Out of 110, 18.18% of study subjects experienced various complications. Among them 9.10% were managed by intrauterine balloon tamponade,2.73% required hysterectomy, and 6.37% were managed by other measures. 70% of respondents stayed in the hospital for 1-3 days, 26.36% for 4 to 7 days, and 3.64% stayed more than 7 days before discharge. Regarding the outcome of retained placenta among study subjects, 80.91% improved and discharged, 10% had severe anemia and required subsequent blood transfusion, 6.36% developed an infection, 0.91% developed acute renal failure and 2 patients died (one due to DIC and another patient due to irreversible shock). Conclusion: The retained placenta is an obstetric emergency. Rapid recognition and treatments are essential because heavy blood loss with coagulation problems remains the lethal factor in this disease. Rapid control of hemorrhage should be the first initiative. Active management of the third stage of labor lowers the danger by a significant percentage.

INTRAUTERINE BALLOON TAMPONADE AS AN EFFECTIVE METHOD OF CONSERVATIVE TREATMENT OF POSTPARTUM BLEEDING

Postpartum haemorrhage (PPH) is the leading cause of maternal mortality worldwide and accounts for approximately a quarter of all maternal deaths today. In May 2021, the World Health Organization (WHO) published updated recommendations that intrauterine balloon tamponade is an effective treatment for postpartum hemorrhage when first-line treatment is ineffective. The implementation of balloon intrauterine tamponade during postpartum hemorrhage after cesarean section appears to be safe and effective, which contributes to the reduction of both invasive procedures and the frequency of transfusions. Objective of the study To evaluate the effectiveness of the complex treatment of hypotonic postpartum hemorrhage and bleeding with placental abruption or placentaaccreta during cesarean section by using intrauterine balloon tamponade to prevent periportal hysterectomy. Methods An analysis of 30 cases of postpartum bleeding, which were treated with intrauterine balloon tamponade (IBT), and ended with effective conservative treatment without hysterectomy, was conducted. Research results and their discussion Parity of childbirth is important as a risk factor for the occurrence of hypotonic bleeding. A stretched uterus due to a large fetus was present in 4 (13.3%), twins - in 3 (10%), polyhydramnios - in 2 (6.6%), that is, every third woman had such a risk factor for bleeding. The course of childbirth plays an important role in the exhaustion of the contractile activity of the uterus and the occurrence of postpartum bleeding. Massive obstetric bleeding was more than 1.5% of the weight in 3 (13.6%) women, up to 1.5% in 17 (77.2%), up to 1% in 2 (9.2%). Intrauterine balloon tamponade was performed for the treatment of PPK after ineffective first-line measures. According to our data, finding an intrauterine balloon gradually stopped the bleeding. 1 hour after UBT of the uterus, the amount of blood loss decreased to 400 ml per hour, gradually decreasing to 4-6 hours. After 6 hours of VBT being in the uterus, the bleeding was stopped and the volume of circulating blood was restored. Conclusions Thus, women who have a history of massive postpartum bleeding, multiparous women, pregnant women with a stretched uterus due to a large fetus, multiple pregnancy, women who give birth with a violation of the contractile activity of the uterus are a risk group for the occurrence of postpartum bleeding. Intrauterine balloon tamponade is an effective method of conservative treatment of postpartum bleeding, which should be widely used in obstetric practice.

Appraisal of Foley’s Catheter as Intra-Uterine Balloon Tamponade in controlling Post-Partum Hemorrhage.

Objective: To appraise the efficacy of Foley’s catheter as balloon temponade in controlling PPH. Study Design: Monocentric Retrospective Impact study. Setting: Department of Obstetrics and Gynaecology of MTI, Hayatabad Medical Complex Peshawar. Period: January 2020 to December 2020. Material &amp; Methods: This is a tertiary care hospital receiving all kind of patients including complicated cases referred by other health care units. All patients of PPH due to uterine atony who failed to respond to medical treatment were managed by using a Foley’s catheter balloon tamponade and made part of this study. Patients with PPH due to genital tract trauma and retained products or whom responded to medical treatment were excluded. The information and relevant data was obtained from the patient’s record and mortality register. Data was analyzed using simple statistical measures and the outcome expressed as frequencies and percentages etc. Results: In this study, 204 patients of PPH due to uterine atony were managed. 83 patients who failed to respond to medical treatment were managed by using a Foley’s catheter balloon tamponade. Balloon tamponade was effective in controlling PPH in 78 (93.98%) cases. Only 5 (6.02%) patients needed further surgical intervention. Conclusion: This study concludes that Foley’s catheter can effectively be used for controlling PPH to save lives and morbidity.