Intrauterine balloon tamponade in the management of postpartum hemorrhage : experience at the Royal Medical Services in Jordan

الملخص EN

-Objective: To describe the practice and efficacy of intrauterine balloon tamponade catheter in two obstetric units and to highlight uterine tamponade as an integral part of the management options of severe post partum hemorrhage in labour ward.

Methods: Fourteen cases of severe post partum hemorrhage had persistent bleeding despite the available conservative measures.

At this point, the Bakri balloon (Cook Medical) was inserted into the uterine cavity.

The balloon was inflated with 300-500 ml of normal saline and left for a maximum of 24 hours, when it was gradually deflated.

The procedure was covered by cefoxitin (Mefoxin) 1g three times daily for 48 hours.

Simple descriptive statistics (mean, frequency and percentage) were used to describe the study variables.

Results: The mean age was 28 (21-35) years.

Six patients were primigravidas (43%).

The causes of post partum hemorrhage were as follows: Six cases of uterine atony, six cases of placenta praevia accreta and two cases of fibroids.

Eight cases followed cesarean section and six cases followed vaginal delivery.

The average blood loss was 1.9 L (1.5-3.5 L).

In total, 59 units of whole blood, 45 units of FFP and 22 units of platelets were given.

On average each patient received 4.2 units of blood, 3.2 units of Fresh frozen plasma and 1.6 units of platelets.

Two cases had evidence of disseminated intravascular coagulation and received Factor VII (two doses each).

The balloon was inflated to an average of 420 ml of Normal Saline (300-500 ml) according to uterine capacity.

In 12 cases (86%), the trial was successful and no further surgery was required.

In two cases (14%) the trial failed and both of these women underwent hysterectomy.

No cases of endometritis were reported in hospitalized patients or on follow up one week after discharge.

Conclusion: Intrauterine balloon tamponade is a valid alternative to less conservative surgical procedures in managing women with post partum hemorrhage.

It is easy, safe, and effective and preserves fertility.

It should be an integral part of labour ward protocols for management of post partum hemorrhage.

Suitable catheters should be available on the labour ward theatres.