Intrauterine balloon tamponade for control of postpartum hemorrhage
- Younes N Bakri, MD
Younes N Bakri, MD
- Sabaratnam Arulkumaran, PhD, DSc, FRCS, FRCOG
Sabaratnam Arulkumaran, PhD, DSc, FRCS, FRCOG
- Professor Emeritus
- Obstetrics and Gynaecology
- St George’s University of London
Postpartum hemorrhage is an obstetrical emergency that can follow vaginal or cesarean delivery. It is one of the leading causes of maternal mortality, especially in the developing world . 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. It can be a life-saving intervention, especially in low-resource settings where blood transfusion and surgical facilities may not be available . Multiple types of balloons catheters are available for uterine tamponade. It is prudent to include one of these devices in postpartum hemorrhage kits.
This topic will discuss the use of intrauterine balloon catheters in the management of postpartum hemorrhage. Detailed information on medical and surgical treatments for postpartum hemorrhage, as well as the causes, can be found separately. (See "Overview of postpartum hemorrhage" and "Management of postpartum hemorrhage at vaginal delivery" and "Management of postpartum hemorrhage at cesarean delivery".)
Use of balloon tamponade and other interventions for management of acute severe menorrhagia are reviewed separately. (See "Managing an episode of severe or prolonged uterine bleeding".)
TYPES OF BALLOON CATHETERS
The following balloon catheters were specifically designed for placement in the uterus for control of postpartum hemorrhage:
●Bakri tamponade balloon catheter – The Bakri tamponade balloon catheter is the first uterine tamponade balloon system designed specifically for the treatment of obstetric hemorrhage . It consists of a silicone balloon (picture 1) (maximum recommended fill volume 500 mL, but volumes up to 1300 mL have been used ) connected to a 24 French silicone catheter 54 cm in length. The collapsed balloon is inserted into the uterus (figure 1); when filled with fluid, the balloon adapts to the configuration of the uterine cavity to tamponade uterine bleeding. The central lumen of the catheter allows drainage and is designed to monitor ongoing bleeding above the level of the balloon (figure 2). The device is intended for one-time use.
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- Sabaratnam Arulkumaran, PhD, DSc, FRCS, FRCOG
- TYPES OF BALLOON CATHETERS
- MECHANISM OF ACTION
- INDICATIONS AND CONTRAINDICATIONS
- After vaginal delivery
- After cesarean delivery
- PERIPROCEDURE MONITORING AND CARE
- SUCCESS RATE
- Comparison with other methods
- OTHER APPROACHES
- External compression plus internal tamponade
- Uterine vessel ligation plus internal tamponade
- SUMMARY AND RECOMMENDATIONS