Postpartum hemorrhage: A Randomized Controlled Trial

Abstract

PPH is the most common cause of maternal morbidity and mortality worldwide. In developing countries the PPH is the main cause of maternal deaths which defined as bleeding from the genital tract of 500ml or more in the first 24 hours following delivery of the baby. Uterine atony is the most common cause of immediate heavy PPH. Although most can be treated successfully with conservative measures, such as medication, about 10% of the women with PPH require major surgical procedures and even hysterectomy to save their lives. There are many drugs which can be used in prevention of atonic PPH as Oxytocin, Ergometrine and Misoprostol. When medical treatments are not readily available, or failure of medical treatment has occurred, or contraindication to medication exists, it is important to have alternative methods of management ready. A variety of surgical techniques are used, including uterine artery ligation, ovarian artery ligation, internal iliac artery ligation, and B-Lynch Brace suture. Each method has benefits and risks. In most cases, the above-mentioned surgical procedures are effective in avoiding hysterectomy, but delay in carrying out the procedure in some cases carries a poorer prognosis. On the other hand, each of the above techniques entails a laparotomy. Uterine packing has been used for long as an alternative to other surgical procedures. A good packing technique entails careful layering of the ribbon gauze pack to occlude the whole space of the uterine cavity, which is much easier in theory than in practice. Keeping the mode of action of the packing in mind, the Sengstaken-Blakemore tube and the Rusch urologic hydrostatic balloon catheter have been used by some researchers to control intractable hemorrhage. The Sengstaken-Blakemore tube is complex to use and expensive. The Rusch urologic hydrostatic balloon catheter, although simple and effective, is also expensive and not available. On the contrary, the price of condom and catheter is cheap and available. The condom was used to create a ballooning function by inflation with a reasonable amount of fluid. This balloon exerts a similar pressure to that of other balloons to the open sinuses of the uterus and stops bleeding. It conforms naturally to the contour of the uterus, does not require any complex packing, and is easy to remove. In addition, it may be associated with lower infection risk as there is no direct intrauterine manipulation. This intervention can be done cheaply, easily, and quickly, and it does not require highly skilled personnel. The aim of this study is to assess the efficacy of uterine tamponade using condom catheter balloon in treatment of atonic postpartum hemorrhage.  Grouping: 88 women included in this study were randomly divided into two groups:  Control group: included 44 women who received 800-μg (4 tablets) of misoprostol alone, given sublingually or intra-rectally.  Study group: included 44 women who received the same dosage combined with the intrauterine balloon tamponade with condom catheter.