Request pdf on jun, 2014, cj arthuis and others published how i do intrauterine balloon tamponade for postpartum haemorrhage. Early use of intrauterine balloon tamponade is a way of limiting ongoing uterine blood loss while initiating other measures, and can be readily implemented by providers with minimal training. A postpartum haemorrhage package with condom uterine. To compare the rates of invasive procedures surgical or vascular for hemorrhage control between a perinatal network that routinely used intrauterine balloon tamponade and another perinatal network that did not in postpartum hemorrhage management. Intrauterine balloon tamponade for severe postpartum hemorrhage. Uterine balloon tamponade ubt is an effective method of addressing uncontrolled postpartum hemorrhage pph from uterine atony. The gdg acknowledges that balloon tamponade can be obtained with specific devices as well as with lower cost adaptations, including those based on the use of condoms and surgical gloves. Us8123773b1 postpartum hemorrhage balloon tamponade. Postpartum haemorrhage pph remains the most common cause of maternal death worldwide. Bakri postpartum balloon with rapid instillation components. Postpartum haemorrhage still remains the leading cause of. The burden of postpartum haemorrhage the world health organization who defines pph as blood loss greater than or equal to 500 ml within 24 hours after birth, and severe primary pph as blood loss greater than or equal to ml within 24 hours.
Keywords maternal mortality, postpartum haemorrhage, resourcepoor settings, treatment, uterine balloon tamponade. Sahithi tirumuru, samiramis saba, hassan morsi, basem muammar. Use of bakri balloon tamponade in the treatment of. Use of the bakri balloon in the management of massive. Bakri balloon tamponade bbt is a novel conservative management option for pph. The purpose of this study is to explore the menstrual and reproductive outcomes for patients who had been managed by intrauterine balloon tamponade for severe postpartum hemorrhage in her. Intrauterine balloon tamponade for control of postpartum hemorrhage. The association between intrauterine balloon tamponade. Intrauterine balloon tamponade in the management of postpartum. Bakri intrauterine balloon catheter was inserted in cases of postpartum hemorhage uncontrolled with uterotonics. Uterine balloon tamponade as an adjunct to misoprostol for. This populationbased retrospective cohort study included all women 72,529 delivering between 2011 and 2012 in the 19. This study is the first randomised controlled trial to test the effectiveness of uterine balloon tamponade ubt by condomcatheter device as an adjunct to misoprostol for the treatment of the postpartum haemorrhage.
Before the bakri balloon device, severe pph were managed by embolization or invasive surgical procedures. Intrauterine balloon tamponade in the management of severe. Postpartum hemorrhage, intrauterine balloon tamponade p ostpartum hemorrhage occurs in. However, there is lack of studies on the menstrual and reproductive outcomes after such treatment. Postpartum haemorrhage is a major cause of death during pregnancy and early motherhood, accounting for 25% of maternal deaths worldwide,1 and is the second leading direct cause of maternal deaths in the uk. Little is known of the effectiveness of this procedure. Although balloon tamponade technology btt is commonly used in the management of postpartum haemorrhage pph secondary to an atonic uterus, btt has been used for other indications including prophylaxis. How i do intrauterine balloon tamponade for postpartum. A bakri balloon is a balloon tamponade specifically constructed for uterine postpartum hemorrhage. Case report complete tamponade system for management. After adjusting for variables that differed statistically between groups, the difference in length of stay associated with intrauterine balloon tamponade duration was no longer present, but the association between intrauterine balloon tamponade duration 12 hours and postpartum fever persisted odds ratio, 2.
Bakri postpartum balloon with rapid instillation 11x17 laminated poster english. The balloon may have a first hemisphere that is located on the catheter distal to second, smaller hemisphere. Guidelines for the management of postpartum hemorrhage involve a stepwise approach including the exclusion of retained products and genital tract trauma. Uterine balloon tamponade ubt is a simple, inexpensive and readily available method used to treat this. In the uterus, balloon tamponade can alleviate or stop postpartum hemorrhage. Pdf intrauterine balloon tamponade for management of severe. This involves inserting a rubber or silicone balloon into the uterine cavity and inflating the balloon with normal saline.
Lowcost devices, such as the esmubt have been shown to be effective without the need for operative intervention. Used to provide temporary control or reduction of postpartum uterine bleeding when conservative management is warranted. Pdf intrauterine balloon tamponade for management of. Successful use of balloon tamponade in the management of.
Postpartum hemorrhage is the leading cause of maternal mortality worldwide in lowresource settings, timely access to surgical facilities may be limited by transport time to tertiary care. Baloon tamponade in management of postpartum haemorrhage 1. We report on three novel uses of an ultralowcost condom uterine balloon. Intrauterine balloon tamponade in the management of. Balloon tamponade in the management of postpartum hemorrhage. The bakri balloon designed as uterine tamponade device have a silicone balloon holds 500 ml of saline and a drainage lumen that allows blood loss monitoring. It consists of a silicone balloon picture 1 maximum recommended fill volume 500 ml, but volumes up to 0 ml have been used 4 connected to a 24. When inflated with sterile liquid, the bakri postpartum balloon with rapid instillation components applies pressure to the uterine walls that may provide management of postpartum hemorrhage. Objective to identify the predictors of intrauterine balloon tamponade iubt failure for persistent postpartum hemorrhage pph after vaginal delivery. Uterine balloon tamponade safe, effective treatment option. A cluster randomized trial reported that the frequency of postpartum hemorrhage related invasive procedures andor maternal death was significantly higher after uterine balloon tamponade introduction than before uterine balloon tamponade introduction 11. Procedure postpartum haemorrhage bakri balloon tamponade uncontrolled document when printed published. The use of balloon tamponade in the control of active variceal bleeding comes as a last resort when other forms of therapy are not available or fail to achieve hemostasis. A qualitative assessment of the impact of a uterine.
Patient suffered from a massive postpartum hemorrhage which was then successfully managed with uterine balloon tamponade. Pph is defined as blood loss greater than 500 mls and continuing. Uterine balloon tamponade in postpartum hemorrhage pph. Endoscopic therapy has replaced balloon tamponade as initial therapy for variceal bleeding. Who recommendation on the use of intrauterine balloon. Sterile gauze was invariably used for uterine packing, but more recently, balloon technology has been used to tamponade the postpartum uterus to control haemorrhage. Case report complete tamponade system for management of severe postpartum vaginal haemorrhage due to uterine atony remzi atilgan,1 zehra sema ozkan,2 ugur orak,2 melike baspinar2 1f. Menstrual and reproductive outcomes after use of balloon.
A qualitative assessment of the impact of a uterine balloon. Sep 21, 2012 home rhl topics preconception, pregnancy, childbirth and postpartum care care during childbirth care during labour 3rd stage who recommendation on the use of intrauterine balloon tamponade for the treatment of postpartum haemorrhage. Pdf on jan 1, 2016, berrin goktug kadioglu and others published balloon tamponade in the management of postpartum hemorrhage. Postpartum hemorrhage is the most common cause of maternal deaths worldwide, the majority of which occur in lowresource settings.
Intrauterine balloon tamponade for management of severe. To evaluate the effectiveness of intrauterine balloon tamponade iubt for management of severe postpartum haemorrhage pph. A balloon tamponade catheter for controlling uterine postpartum hemorrhage has an elongated body with a balloon at a marginal distal end of the elongated body for insertion into the uterus. Uterine balloon tamponade for the treatment of postpartum haemorrhage in resourcepoor settings. It is an obstetric emergency that needs to be managed promptly and effectively to reduce the risk of morbidity and mortality. Statement on uterine balloon tamponade in post partum. Balloon tamponade is considered a bridge to more definitive treatment modalities, and is usually administered in the emergency department or in the intensivecare unit setting, due to the illness of patients and the complications of the procedure. Massive postpartum hemorrhage pph is one of the most serious complications during delivery. The balloon cited in these case reports is the bakri postpartum balloon cook medical, usa. Maternal outcomes after uterine balloon tamponade for postpartum. The method of uterine tamponade using balloons has recently been added to the armamentarium for managing pph. Uterine balloon tamponade provides a necessary option to tamponade bleeding while transport occurs to. Balloon tamponade in the management of postpartum haemorrhage aboubakr elnashar benha university hospital, egypt aboubakr elnashar 2. Once postpartum hemorrhage has been identified and medical management given including agents such as uterotonics and tranexamic acid, ubt may be employed to tamponade uterine bleeding without the need to pursue operative intervention.
It is one of the leading causes of maternal mortality, especially in the developing world. To evaluate the effectiveness of balloon tamponade in the management of postpartum hemorrhage pph. Predictors of failed intrauterine balloon tamponade for. Intrauterine balloon tamponade has emerged as a widely recommended technique to avoid invasive procedures. A postpartum haemorrhage package with condom uterine balloon. Balloon tamponade in the management of postpartum haemorrhage. There should be a low threshold for use of balloon tamponade as it is effective, easy to use, easily available, has low complication rate, and an inexpensive modality to manage nontraumatic postpar tum haemorrhage, especially in. Thus balloon tamponade is an effective adjunct in the treatment of severe postpartum hemorrhage, especially when due to uterine atony when medical therapy fails. System, ebb balloon, intrauterine balloon tamponade, postpartum haemorrhage. Uterine balloon tamponade ubt is a simple, inexpensive and. Learning objectives identify causes of postpartum hemorrhage and chorioamnioitis define methods for prevention and management of postpartum hemorrhage and chorioamnioitis. Thus balloon tamponade is an effective adjunct in the treatment of severe postpartum hemorrhage, especially when due to uterine atony when. The balloon and catheter are constructed of 100% silicone.
Intrauterine balloon tamponade in the management of postpartum hemorrhage in the obstetrics emergency ward in menoufiya university hospitals as a low resource setting. The use of intrauterine balloon tamponade to manage postpartum hemorrhage is increasing. While effective, commercially available devices may be expensive for settings in which postpartum hemorrhage is most common. The method of uterine tamponade using balloons has. Dec 22, 2015 post partum haemorrhage, severe acute maternal morbidity and the condom catheter uterine tamponade. Innovative uses of condom uterine balloon tamponade for. Postpartum haemorrhage bakri balloon tamponade the royal. Conclusion bakri balloon tamponade is an effective means of managing massive postpartum haemorrhage, and should be adopted in protocols to manage such patients. Clinical success was defined as control of bleeding without need for further. Sep 27, 2017 postpartum haemorrhage is a major cause of death during pregnancy and early motherhood, accounting for 25% of maternal deaths worldwide,1 and is the second leading direct cause of maternal deaths in the uk. Postpartum haemorrhage pph is defined as blood loss of 500ml or more within 24 hours after birth. Obstetric haemorrhage is a significant contributor to worldwide maternal morbidity and mortality.
Purpose this document outlines the procedure details for the use of balloon tamponade in managing primary major postpartum haemorrhage at the womens. The effectiveness and safety of introducing condom. This disposable device is made of silicone rubber and. However, balloon tamponade technology is rapidly becoming accepted as a preferred second line approach following failed first line uterotonics in many obstetric units. Sep 01, 2017 this study is the first randomised controlled trial to test the effectiveness of uterine balloon tamponade ubt by condomcatheter device as an adjunct to misoprostol for the treatment of the postpartum haemorrhage. Guidelines for the management of postpartum haemorrhage pph involve a stepwise escalation of pharmacological and eventual surgical approaches. It bears the significance of being one of the very few reported cases of successful nonsurgical management of postpartum hemorrhage in a bicornuate uterus with balloon tamponade. Postpartum haemorrhage pph is an obstetric emergency that accounts for 25% of maternal deaths globally1. Department of obstetrics and gynaecology, russells hall hospital, dudley hospitals nhs foundation trust, dudley, uk. The balloon may have a first hemisphere that is located on the catheter distal to second, smaller. Use of balloon tamponade in management of severe vaginal. Pdf balloon tamponade in the management of postpartum. Setting all women who underwent iubt for persistent pph after vaginal delivery from january 2011 to december 2015 in these hospitals.
Baloon tamponade in management of postpartum haemorrhage. Home rhl topics preconception, pregnancy, childbirth and postpartum care care during childbirth care during labour 3rd stage who recommendation on the use of intrauterine balloon tamponade for the treatment of postpartum haemorrhage. Condom catheter balloon tamponade was an effective means of controlling postpar tum haemorrhage. Uterine balloon tamponade for the treatment of postpartum. Intrauterine balloon tamponade for severe postpartum. Intrauterine balloon tamponade for the control of postpartum. Use of an innovative condom balloon tamponade in postpartum. Balloon tamponade an overview sciencedirect topics.
The balloon preferably has a pearshaped appearance. Postpartum hemorrhage is an obstetric emergency that can follow vaginal or cesarean delivery. Postpartum haemorrhage pph postpartum haemorrhage pph is one of the main causes of maternal death worldwide. Design retrospective caseseries in five maternity units in a perinatal network. This study was realised in real condition of medical care in order to test the real interest of this treatment. Post partum haemorrhage, severe acute maternal morbidity and the condom catheter uterine tamponade. To evaluate the effectiveness and safety of an ultralowcost uterine balloon tamponade package esmubt for facilitybased management of uncontrolled postpartum haemorrhage pph in kenya, sierra leone, senegal, and nepal. Diagnosis and management of postpartum haemorrhage the bmj. Postpartum haemorrhage bakri balloon tamponade uncontrolled document when printed published. In is only available as intrauterine balloon device. Intrauterine balloon tamponade in the management of severe postpartum hemorrhage. Uterine balloon tamponade ubt is a nonsurgical method of treating refractory postpartum hemorrhage.
The severe bleeding persisted despite total abdominal hysterectomy, pelvic embolization and vaginal gauze packing, but was finally controlled by a bakri balloon tamponade inserted into the vagina. Louis chaptini, steven peikin, in critical care medicine third edition, 2008. Bakri postpartum balloon catheter the bakri tamponade balloon catheter is the first uterine tamponade balloon system designed specifically for the treatment of obstetric hemorrhage. Postpartum hemorrhage connie hogewood, msn rn cathy roche, phd, rn disclosure we have no actual or potential conflict of interest in relation to this presentation.
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