M-AFRAKHTEH. MD OCT.2017 SHOHADA HOSPITAL TAJRISH

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2 M-AFRAKHTEH. MD OCT.2017 SHOHADA HOSPITAL TAJRISH

3 Patients at imminent risk of exsanguination Manual aortic compression Resuscitative endovascular balloon occlusion of the aorta Uterine tourniquet Intrauterine balloon tamponade Ligation of uterine and utero-ovarian arteries Pelvic packing Clamp across utero-ovarian ligaments

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23 Intrauterine balloon tamponade for control of postpartum hemorrhage

24 Sengstaken-Blakemore tube (used for treatment of bleeding esophageal varices) Single or multiple Foley catheters (used for bladder drainage) Rusch urologic balloon (used for stretching the bladder) Condom catheter (a condom is placed over the end of a Foley-type catheter, the base of the condom is ligated to the catheter to prevent leakage, and then the condom is filled with up to 500 ml fluid via the catheter Size 8 surgical glove tied to an intravenous infusion or other catheter, and then filled with up to 500 ml

25 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 ( (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 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. The device is intended for one-time use.

26 Indications Intrauterine balloon tamponade is indicated when uterotonic drugs and bimanual compression of the uterus fail to control bleeding. Its use is indicated before resorting to more invasive surgical approaches requiring laparotomy. If bleeding persists, arrangements should be made for definitive treatment, which may include transferring the patient to another facility. Balloon tamponade is often successful, obviating the need for arterial embolization or an open surgical intervention.

27 Most cases where intrauterine balloon tamponade has been used successfully involved acute postpartum hemorrhage due to uterine atony. Intrauterine balloon catheters have also been used with variable success to control or reduce bleeding after cesarean delivery with placenta previa, low lying placenta, or a focally invasive or adherent placenta. A small number of cases of delayed (secondary) postpartum hemorrhage have been successfully managed with balloon catheters

28 Contraindications Intrauterine balloon tamponade is contraindicated in postpartum patients allergic to any component of the device and in clinical settings where tamponade is unlikely to be effective (eg, bleeding from pelvic vessels or cervical or vaginal trauma; uterine abnormalities that prevent effective balloon tamponade; suspected uterine rupture; cervical cancer; and purulent infection of the vagina, cervix or uterus).

29 As with any emergent clinical situation, one must assess the risks and benefits to placement of the intrauterine balloon and proceed accordingly. These devices should not be used when a large amount of placenta is adherent to the uterus and immediate hysterectomy may be life-saving. They should not replace evacuation of retained products of conception or antibiotic treatment of infection.

30 After vaginal delivery Ensure that the bladder is empty by placing a bladder catheter. Fill a sterile basin with the maximum volume of sterile fluid that can be instilled, but at least 500 ml. Alternatively, a 1 L crystalloid infusion system can be used. Cleanse the cervix and vagina with an antiseptic solution, such as povidone iodine. Perform a second visual inspection of the vagina and cervix to ensure the absence of bleeding lacerations as the source of the hemorrhage. Bleeding lacerations should be repaired. Check the placenta to ensure that it is complete. Perform a gentle digital examination of the uterine cavity to make sure it is empty

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