Management of postpartum hemorrhage by uterine balloon tamponade: prospective evaluation of effectiveness.
Doumouchtsis SK., Papageorghiou AT., Vernier C., Arulkumaran S.
OBJECTIVE: To evaluate uterine balloon tamponade in the management of postpartum hemorrhage (PPH). Method and study design. Prospective audit. Setting. St George's Hospital, London. POPULATION: Twenty-seven women with intractable PPH managed by uterine balloon tamponade using a Sengstaken-Blakemore Oesophageal Catheter (SBOC) when medical management was not effective, and prior to surgical intervention. MAIN OUTCOME MEASURES: Success rate of the SBOC in arresting hemorrhage. The need for additional measures, use of anesthesia and complication rates is reported. RESULTS: During the study period there were 27 women who had placement of the catheter. In 22 cases (81%) hemostasis was achieved, while in five cases (19%) the SBOC failed in arresting hemorrhage. Of the five failures, hysterectomy was required in four cases and in the remaining case the failure was associated with expulsion of the balloon, but hemostasis was achieved with further conservative measures. Among the failed cases there was one maternal death due to amniotic fluid embolism with cardiac arrest and PPH secondary to coagulopathy. In cases where the balloon was successful it was removed around 24 hours later. In these cases no further bleeding was observed, and no complications occurred from the procedure. CONCLUSIONS: Placement of a SBOC successfully treats atonic PPH refractory to medical management in around 80% of cases. It is simple, inexpensive and in those with successful placement no surgical morbidity was observed. The potential for it to be used by inexperienced operators in areas with limited resources makes it a useful adjunct in management of PPH.