Birth Challenges, Global Midwifery

Postpartum Hemorrhage – Uterine Balloon Tamponade

This morning I’m reading a study about the demand for training in uterine balloon tamponade in the US.1 It caught my eye because I had conversations about uterine balloon tamponade with midwives from other countries at the ICM Congress. The idea is not new, balloon tamponade to occlude esophageal varices has been used for decades. Medscape has a clinical procedure brief about the technique for anyone wanting more information.

My conversation with the midwives was about the creativity employed in low resource settings to create balloon tamponades out of condoms and catheters, a technique that has been described in the literature.2, 3

I have to admit, I like the concept. It isn’t perfect. Even in well-resourced hospitals, the technique had an overall success rate of 65%.4 It doesn’t address all reasons for bleeding, but can be effective to slow the bleeding to allow other treatments.5 The technique also does not address the problem that a woman must be with a skilled birth attendant and the materials must be available.

1.
Zaid A, Emily de R, Hao D, Daniela S-R, Thomas FB. Uterine balloon tamponade for the management of uncontrolled postpartum hemorrhage by midwives and family physicians. International Journal of Nursing and Midwifery. 2017;9(8):109-112. doi: 10.5897/ijnm2017.0280
2.
Mishra N, Agrawal S, Gulabani K, Shrivastava C. Use of an Innovative Condom Balloon Tamponade in Postpartum Haemorrhage: A Report. The Journal of Obstetrics and Gynecology of India. 2015;66(1):63-67. doi: 10.1007/s13224-015-0818-2
3.
Mishra N, Shrivastava C, Agrawal S, Mahilange A, Sai MM, Gulabani K. Easy Balloon: The Easiest to Assemble Condom Balloon Uterine Tamponade for Primary Level of Health Care Centres. The Journal of Obstetrics and Gynecology of India. 2017;67(5):378-381. doi: 10.1007/s13224-017-1014-3
4.
Martin E, Legendre G, Bouet P-E, Cheve M-T, Multon O, Sentilhes L. Maternal outcomes after uterine balloon tamponade for postpartum hemorrhage. Acta Obstetricia et Gynecologica Scandinavica. 2015;94(4):399-404. doi: 10.1111/aogs.12591
5.
Dildy GA, Belfort MA, Adair CD, et al. Initial experience with a dual-balloon catheter for the management of postpartum hemorrhage. American Journal of Obstetrics and Gynecology. 2014;210(2):136.e1-136.e6. doi: 10.1016/j.ajog.2013.09.015
Jennifer (Author)