Intrauterine Packing 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.

Implementing uterine balloon tamponade (UBT) device for immediate postpartum hemorrhage management: Leveraging resource allocation and highlighting noteworthy experiences

BackgroundThe use of uterine balloon tamponade (UBT) devices for intrauterine packing and management of vaginal bleeding by uterine atony has shown promising results in improving the quality of care and reducing maternal mortality. ObjectiveThis report aims to provide an overview of progress made in implementing UBT devices in northern Cote d'Ivoire. Material and methodsA four-year retrospective study was conducted in the North-East (163,645), North-Center (351,909), and North-West (57,983). In 2017, UBT was adopted by members of the healthcare system. Subsequently, 5 national and 32 regional trainers have been trained. The training session was a theoretical and practical program with a low simulator. UBT is a male condom tied to a urinary catheter, filled with liquid. Positive outcomes included stopping bleeding, avoiding the need for surgery, and preventing maternal deaths (MD). In 2018, 3,515 UBT devices were distributed. In 2019, monitoring tools and transmission circuits of the data were validated. In 2020, the collection of data and local manufacturing was launched. ResultsDuring the process, 978 health workers, mainly midwife (52.0%) and nurses (32.2%) out of the 1,295 assigned were trained. The number of trained individuals decreased from 209 in 2019 to 160 in 2020. A total of 1,715 UBT devices were locally manufactured, adding to the existing gift of 5,080 devices, with total availability of 6,795. The distribution of devices increased from 2017 to 2019 but decreased in 2020. Success rates increased from 87.3% in 2017 (365/418) to 95.0% in 2019 (556/585) and slightly decreased in 2020 to 98.0% (681/695). Adverse outcomes (144/2,193), included MD (35/2,193) and medical evacuation to the surgical center (109/2,193). ConclusionThe implementation of UBT in northern Cote d'Ivoire successfully reduced maternal death rates caused by immediate post-partum hemorrhage (IPPH). However, to ensure sustainability, further improvements are needed, including increased monitoring, ongoing training, and device availability.

Pivotal Role of Management of Postpartum Haemorrhage by Using Intrauterine Pack during Caesarean Section

Background: Postpartum Haemorrhage (PPH) is a potentially life-threatening complication after delivery by both vaginal and caesarean section (CS). Different types of management options have been available in clinical settings including the use of oxytocin, prostaglandin analogues, ergometrine, surgical exploration of genital tract, ligation or angiographic embolization of uterine or internal iliac arteries and hysterectomy. Another simple and effective measure to manage PPH is to control the bleeding with intrauterine packing by mop during CS. This intrauterine packing during CS is very easy & quick method to perform and it has pivotal role to save the patient need of major surgical procedures.
 Objective: To determine effectiveness of uterine packing by mop in control of post-partum hemorrhage, its safety and complications associated with it.
 Materials and Methods: This study was carried out in Obstetrics & Gynaecology department of Eastern Medical College & Hospital, Cumilla, Bangladesh from January 2020 to July 2020. It was a prospective interventional study. the patients presenting with postpartum haemorhage during CS due to atonic uterus. Patients who had PPH due to genital tract trauma were excluded from this study. Frequencies and proportions of complications were calculated along with rate of successful cessation of bleeding by the use of intrauterine mop. Data was analyzed by SPSS.
 Results: 100 patients included in the study. Among them 63% were 25-34 years, 26% were 15-24 years, 11% were 35-45 years. 73% patients were p >3 and 27% were p 1-3. 77% patients belong to poor class family, 18% belong to middle class and 5% belong to high class family. These patients went through LUCS and had atonic uterus. Mop was used in those patients and successes rate were 87%. In 13% cases we needed others management. These were 11% case uterotonic drugs, 1% B-Lynch suture, 1% internal iliac artery ligation but none out of 100 patients underwent hysterectomy.
 Conclusion: Uterine packing by mop effectively controls PPH with fewer complications and its role in emergency obstetric scan not be denied.
 EMCJ. July 2022; 7(2): 1-5

Intra-uterine packing: an effective and affordable tool in the management of post-partum hemorrhage - cohort study.

postpartum hemorrhage is the main cause of maternal death worldwide. Uterine balloon packing has shown promising outcomes in PPH management. Nevertheless, its usage is limited in low- and middle-income countries due to associated costs. Uterine packing using gauzes presents a potentially efficient and cost-effective alternative. This study aims to assess the safety and efficacy of intra-uterine packing with gauzes in managing postpartum hemorrhage. this was a retrospective study over a period of two years and six months. All patients who experienced PPH due to uterine atony during vaginal delivery, with no response to medical first-line treatment, were included. IUP using gauze was employed as a second-line intervention. The primary outcome was the success of postpartum hemorrhage management. Secondary outcomes included patient vitals, the need for blood transfusion, change in hemoglobin levels (delta Hemoglobin), and maternal morbidity (post-partum infection, Sheehan syndrome, and retained gauzes). the study included 63 patients. The mean age was 30.06 ± 5.6, the mean gravida was 2.65 ± 1.9 and the mean para was 2.12 ± 1.31. None of these patients experienced major complications following gauze insertion. Three patients underwent laparotomy and conservative surgical management was performed. Hysterectomy was not required for any participant, and no maternal deaths were recorded.

Uterine packing with chitosan-covered gauze compared to balloon tamponade for managing postpartum hemorrhage

BackgroundPostpartum hemorrhage (PPH) is a major cause of maternal death worldwide. Management of PPH includes the administration of uterotonics, and intrauterine packing techniques. ObjectiveIn this study the effectiveness and safety of chitosan covered gauze versus a balloon tamponade for managing severe PPH should be assessed. Study designThis retrospective cohort study was conducted at the Department of Obstetrics, Charité, university hospital Berlin, between October 2016 and June 2018. Women with PPH were treated according to management guidelines. When bleeding persisted, we applied additional uterine packing with either chitosan covered gauze or a balloon tamponade. The primary outcome was uterine bleeding termination without additional surgical interventions. Secondary outcomes included the amount of blood loss, the amount of blood transfusions and maternal complications. ResultsAmong the 78 patients included in this study, 47 (60.3%) received chitosan covered gauze tamponade and 31 (39.7%) received a balloon tamponade. The major reason for PPH was atonic bleeding, no statistically significant group differences were observed. With respect to the outcomes monitored, the groups were not significantly different in postpartum vital signs, hemoglobin levels, blood loss, admission to intensive care unit, or inflammation parameters. However, three patients in balloon tamponade group required a hysterectomy. No hysterectomy was required in gauze group. ConclusionChitosan covered gauze is an excellent option for treating PPH, it appeared to be at least equivalent to the balloon tamponade, in our experience particularly suitable for atony or placenta bed bleeding after spontaneous delivery or during cesarean sections, in cases of lower uterine segment atony, placenta previa bed bleeding, and/or coagulopathy.

Efficacy and Safety of Intrauterine Balloon Tamponadeversus Uterovaginal Roll Gauze Packing in Patient Presenting with Primary Postpartum Hemorrhage after Normal Vaginal Delivery.

Objective| To compare the effectiveness and safety profile of intrauterine balloon tamponade with uterovaginal roll gauze packing among patient of primary postpartum hemorrhage after normal vaginal delivery. Duration of Study| This study was conducted in the Department of Obstetrics & Gynaecology, of a Tertiary Care Hospital, Lahore from December 2015 to November 2016. Patients and Methods| In this Randomized controlled trial,212 patients of age range 20 to 40 years who presented with postpartum hemorrhage after a normal vaginal delivery (NVD) those who did not responded to medical treatment were included. Cases of PPH due to perineal, cervical or vaginal tear, episiotomy, retained placenta, coagulation disorder, secondary PPH and PPH with normal vaginal delivery after previous cesarean section were excluded from this study. Subjects were randomly assigned to either intrauterine balloon tamponade or uterovaginal roll gauze packing. Intrauterine packing (IP) was removed after 24 hours and balloon tamponade after 24 hours of insertion. Antibiotic coverage was also given to prevent intrauterine infection. All females were kept under observation in ward. Effectiveness was labeled if bleeding was stopped within 15 minutes after uterovaginal packing or balloon tamponade (BT) and patient remain hemodynamically stable and if no complications occur after applying or removing balloon tamponade or intrauterine packing safety was labeled. Data was analyzed by SPSS version 20.2.Frequencies and percentage of complications were calculated along with rate of successful cessation of bleeding were calculated. Result| Mean age group of woman in whom balloon tamponade and intrauterine packing was used was 29.22+6.52 and 29.05+ 6.802 years. Mean gestational age of woman in BT and IP group and was 39.95+1.304 and 38.98+ 1.428 years. Mean blood loss in woman in BT and IP group was 600.28+ 25.338 and 669.21+70.176 ml. Efficacy of group BT was 78(73.6%) and in IP was 63(59.4%).Safety of BT group was 97(91.51%) and IP group was 55(51.88%). Treatment of balloon tamponade was more effective and safe than intrauterine packing in female presented with PPH after normal vaginal delivery (p < .05). Conclusion| This study concluded that balloon tamponade is an effective and safe method than intrauterine packing for the management of PPH after normal vaginal delivery.

Success of Pavlik Harness Treatment Decreases in Patients ≥ 4 Months and in Ultrasonographically Dislocated Hips in Developmental Dysplasia of the Hip.

Treatment of developmental dysplasia of the hip (DDH) using the Pavlik harness has been a widely used method in patients between 0 and 6 months of age for many years. However, the factors influencing the success rate of this treatment modality have still not exactly been determined as a result of the limited number of clinical studies with higher level of evidence. We, therefore, asked whether (1) patient-related variables such as age, gender, and laterality; coexisting risk factors including family history, breech presentation, intrauterine packing, first-born girl, oligohydroamnios, and swaddling; and (2) the severity of hip dysplasia, defined by ultrasonography, are associated with differences in the success rate of Pavlik harness treatment in infants with DDH. Between 2012 and 2014, we treated 153 children (≤ 6 months of age) with DDH using the Pavlik harness. Hip dysplasia apart from coexisting neuromuscular disorders, congenital abnormalities, or syndromes was our inclusion criteria. Of patients thus treated, 130 (85%) were available for the evaluation of patient- and hip-related variables against the success of Pavlik harness treatment. Mean age of these patients on day of diagnosis and initiation of treatment was 108 days. The diagnostic and followup examinations of the hips were made by ultrasonography using Graf's method. Pavlik harness treatment was initiated in Graf Type IIa- and worse hips and treatment was considered "successful" when a Graf Type I hip was achieved. Pavlik harness treatment was successful in 92 (71%) patients (130 of 181 hips [72%]). Age was the only patient-related variable influencing the success rate of the treatment; the mean age of children in whom Pavlik harness treatment succeeded (97 ± 38 days; 95% confidence interval [CI], 90-112) was lower than the age of those who failed (135 ± 37 days; 95% CI, 123-147; p < 0.001). The highest success rate was obtained in children younger than age 3 months (37 of 40 [93%]) and the lowest one older than age 5 months (nine of 24 [37%]) (p < 0.001). The threshold age value related to an increased risk of failure was found to be 4 months and older, which had a sensitivity of 66% and a specificity of 77% (p < 0.001). A higher initial α angle was observed in the hips in which the treatment succeeded (53° ± 6°; 95% CI, 51°-53°) than in those that failed (47° ± 7°; 95% CI, 45°-50°; p < 0.001). The threshold α angle value related to an increased risk of treatment failure was 46° and less, which had a sensitivity of 47% and a specificity of 86% (p < 0.001). Dislocated hips (Graf Type III and IV hips) had the lowest rate of treatment success (five of 19 [26%] and two of four [50%], respectively), whereas Graf Type IIa- hips had the highest (27 of 29 [93%]) (p < 0.001). We conclude that Pavlik harness treatment is less effective in children at and over the age of 4 months at the time the harness is first applied as well as in hips with complete dislocations and hips with severely deficient acetabular bony roofs. In such older patients and worse hip types, the use of initial Pavlik harness treatment needs to be revisited. Future studies, comparing the outcomes of the Pavlik harness treatment and other types of interventions in such patients and hip types, are needed. Level III, therapeutic study.

Management of life-threatening uterine hemorrhage in a young patient with choriocarcinoma

A 22-year-old primigravida who underwent medical abortion at 45 days of amenorrhea was diagnosed to have choriocarcinoma by histopathological examination after dilatation and curettage (D and C) for persistent bleeding per vaginum. Her serum β human chorionic gonadotropin values were less than 1 lakh and she was treated initially with methotrexate monotherapy elsewhere. She needed 10 units of packed cell transfusion for persistent hemorrhage and she was referred to our Institute because of persistent gestational trophoblastic neoplasia and intractable hemorrhage. She needed multiple transfusions and underwent laparotomy and bilateral internal iliac artery ligation with intrauterine packing as she had a severe bout of bleeding resulting in hemorrhagic shock. Post-operatively she was managed with chemotherapy employing EMACO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine/oncovine) and EMA (etoposide, methotrexate, actinomycin D) and thus her fertility was preserved.

137Cs afterloading intrauterine packing for stage I and stage II adenocarcinoma of the endometrium.

Eleven patients with Stage I or Stage II adenocarcinoma of the endometrium were treated with 137Cs afterloading intrauterine packing. Treatment results and complications were similar to those obtained with radium afterloading tandems and colpostats (20 patients) and Heyman packing (2 patients). 137Cs is preferable in patients with roomy or irregular intrauterine cavities and also offers reduced radiation exposure to personnel.

Medroxyprogesterone acetate release from Silastic devices as replacement for local irradiation by radium tubes in preoperative intrauterine packing for endometrial adenocarcinoma: A preliminary study

For radioprotective purposes a preliminary evaluation is made of the possibility of substituting local hormonotherapy by means of a medroxyprogesterone-releasing intrauterine Silastic device for conventional radium packing as a preoperative procedure in the therapeutic scheme of Stage I endometrial adenocarcinoma. Anatomopathologic examination of operative specimens belonging to 17 experimental patients and to 27 control patients revealed no important differences; both preoperative procedures produced a total destruction of endometrial adenocarcinoma in about 60% of the cases without myometrial invasion. These data have induced the start of a large-scale randomized trial on this problem.

The Value of Intra-Uterine Douches, Packing and Antiseptics in the Treatment of Miscarriage; A Study of the Results in Two Thousand Cases

The Value of Intra-Uterine Douches, Packing and Antiseptics in the Treatment of Miscarriage; A Study of the Results in Two Thousand Cases