Balloon Tamponade in Post partum Hemorrhage

1. Balloon Tamponade in
Post partum Hemorrhage
DR SHARDA JAIN DR SANGEETA GUPTA DR JYOTI AGARWAL

3. Dr Jyoti Agarwal
MBBS (Gold Medalist)
M.D (Gynae & OBST )
FICOG, PGDMLS
Senior consultant & Director
* Lifecare Centre
* Lifecare IVF
 Ex President of D.G.F.(East)
 Treasurer : Delhi Gynaecologist Forum
 D.G.F. Certified Trainer for
* Infertility - IVF
* Ultrasound
* Colposcopy + Thermal Ablation
 Awards
* APJ Abdul kalam’s Appreciation Award DGF “East” 2015
* “THE TEACHERS EXCELLENCE AWARDS” DGF 2017
* APJ Abdul kalam’s Excellence Award DGF “East” 2020

4. All pregnant women are at risk of dying
even if no predisposing factors are present

6. PPH is the cause of 25% of maternal
deaths in India in 2021

10. In women who have not responded to treatment
with uterotonics (i.e. drugs) or if uterotonics are
not available the use of an intrauterine balloon
should be considered in the treatment of
postpartum hemorrhage due to uterine atony
provided woman is stable.
INTRAUTERINE BALLOON

11. It can save 90% of Hysterectomy if
done promptly by Nurses & Doctors
at 1st Delivery place

12. UTERINE TEMPONADE
This intervention does require training and
there are risk associated with the procedure
such as infection and perforation of the uterus.
A Sengstaken tube , Bakri balloon and even an
inflated condom BALLOON or glove balloon
have been used with success in different
settings.

13. INDICATION & TIMING OF UTERINE
BALLOON TAMPONADE
• Uterine balloon tamponade following a vaginal
delivery and atonic postpartum hemorrhage , that
is unresponsive to uterotonics ( drugs ), prior to
interventional surgical procedures such as the-B
lynch suture , uterine artery embolization or iliac
artery ligation or hysterectomy being considered .
• It can be used during or after cesarean section and
in a women with vaginal birth after previous
cesarean section with postpartum hemorrhage
after excluding rupture .

14. Bakri
Condom Balloon

17. How to use
Insert the balloon and instill warm sterile water /
saline in increments of 50ml while observing for
bleeding from the cervix when bleeding stops
install an extra 50 ml .It should be immediately
effective-i.e.5-15 min
If bleeding continues despite the balloon
herniating via the cervix, the treatment is unlikely
to be effective and the balloon will be expelled.
The next step should be compression suture.

18. The fundal height should be marked and the
height monitored with vaginal bleeding, pulse
,blood pressure and urinary output to identify
signs of unstable patient & continued bleeding
Prophylactic antibiotics and slow IV oxytocin
infusion is advised.

19. How long to keep Intra Uterine Balloon
if found effective ?
The balloon tamponade if effective can be
removed after 4-6 hours ;although it is usually
left overnight to stabilize the patient.
Once the fluid in the balloon is withdrawn ,
check for bleeding .
If there is no further bleeding for 30 minutes ,
remove the balloon

20. How to use a condom if no alternative
is available
• Open the condom, insert the end of a piece of tubing
from an IV set or Foley,s catheter into the condom tie
securely with sterile string , insert the condom into
the uterus vi the cervix , release fluid from the IV
bottle down the tubing and into the condom (or
glove) until it has expended fully between the walls
of the uterus .
• NB to see a video
• Demonstration of this procedure , go to
www.glow.com

21. Aortic compression
If bleeding is severe and if initial measures are not
successful, then external aortic compression should be
considered.
Successful aortic compression , is achieved when the
femoral pulse not felt and when blood pressor in the
lower limbs is unrecordable .
It may be benefit as a temporary measure in the
management of postpartum hemorrhage whilst
resuscitation and other management plans are made

22. • Internal aortic compression can also be used
as a temporary measures to control severe
postpartum hemorrhage due to placenta
percreta during cesarean section.
• NB to view a video demonstrating how to
apply aortic compression visit
• www.glow.com

23. AORTIC COMPRESSION

25. Take Home Message
Uterine Balloon Therapy to be done
• At 1st Point of delivery for atonic PPH if patient is
stable  effect will be seen within 10 minutes
• Sooner rather than later
• Need to perform fast / Rapid
• It should be part of PPH kit
Nurses & Doctors should remember
No Use of saving the uterus and loosing the mother