POST PARTUM HEMORRHAGE;

EFFICACY OF BALLOON TAMPONADE IN THE MANAGEMENT

Abstract

Primary postpartum hemorrhagic, rightly called as obstetrician’s nightmare,
refers to excessive blood loss of more than 500ml during the third stage of labour or in the first
24 hours after delivery. It continues to be one of the leading causes of maternal mortality and
morbidity all over the world including Pakistan where it is responsible for 21-31% of maternal
mortality and morbidity. Objectives: Objective of study was to determine the efficacy of balloon
tamponade in the management of primary PPH, so that a low cast, easy to use technology is
available for conserving future fertility by treating postpartum hemorrhage. Settings: Department
of Gynae & Obs, Allied Hospital, Faisalabad. Study Design: Descriptive cross sectional study.
Study Period: 6 months from 1st Oct, 2015 to 31st March, 2016. Material & Methods: All patients
delivered vaginally at term (after 37 completed weeks of gestation) who developed PPH due to
uterine atony after failure of conventional medical therapy were included in this study. Patient
selection was based on inclusion and exclusion criteria. Their demographic profile and efficacy
of balloon tamponade was checked in terms of time required to control hemorrahage and
need of laparotomy. Results: During study period total no. Of vaginal deliveries were 3000.
Out of these 298 developed PPH, 220 had PPH due to uterine atony and did not respond to
conventional medical therapy. The age of patients ranged between 22 and 40 years with mean
age of 30 year (±4.88SD). The parity of the patients ranged between 1 and 14 with the mean
parity of 4 (±2.26SD). The condom catheter was introduced in all the selected 80 patients and
was successful in 73 patients. Conclusions: In developing countries such as Pakistan where
the maternal death rate from PPH is very high, this safe, in expensive and easy procedure (it
does not require any expertise) can be applied in any situation to save a life and to save the
uterus in young patients to conserve reproductive capacity and prevent them from surgery and
its morbidity. This will protect the patients from irreversible shock and even death with a success
rate of 85-95%.