Uterine balloon tamponade 2024

Hi guys, welcome to medical advice channel, in today’s article we will be discussing about Uterine Balloon Tamponade. Uterine balloon tamponades are devices used to arrest postpartum hemorrhage thus preventing severe bleeding.

Don’t confuse a tampon with uterine balloon tamponade. A uterine balloon tamponade prevents postpartum haemorrhage by applying pressure to the bleeder (a bleeder may be a vein or tissue). A tampon, on the other hand, is a tube-like pad used by ladies when during their periods. It is simply inserted into the vagina and it collects or in a more suitable term, absorbs the menstrual blood.

Principles of using uterine Balloon tamponade

To use a uterine balloon tamponade, you must rule out other causes of a postpartum haemorrhage such as lacerations, retained placenta, empty uterine clots, and tears. If the is a retained placenta, it should be completely removed, and in the event of a tear, it should be repaired first.

During the procedure, the woman should be placed in a Lloyd Davies position, commonly known as the lithotomy position, this is a common position used in obstetric procedures that involve access to a woman’s sexual organs and during delivery. This is because the position makes the uterus more accessible in a manner that can not cause any harm.

Anaesthesia

Should be administered during the procedure. Remember that there is bleeding, and possibly pain, and therefore it is not a procedure to be done without anesthesia.

Other measures to try and stop the bleeding should have been explored before using this method. Uterotonic drugs such as oxytocin, misoprostol or tranexamic acid should have failed to stop the bleeding.

Hemostatics such as iron folic acid and blood transfusion must be available. This is in order to restore lost blood and help the body in replacing the lost haemoglobin.

There must be a functional operating theatre which is accessible and functional. This is helpful in case the bleeding is excessive which might be life-threatening.

Ways of performing a uterine balloon tamponade

A balloon that is filled with water is inserted into the uterus, reducing the pressure on the systemic artery.

Packaging using several rolls of gauze packed inside the uterus to put pressure on the bleeder and try help in the formation of a clot that will help close the bleeder.

Ways of testing a Uterine tamponade

Once the catheter or balloon is firmly in situ, it’s tested by application of gentle traction, if minimal or no bleeding was observed at the cervix, or there was only minimal bleeding into the gastric lumen or the Cather then it was considered a success, in this case, a possible hysterectomy was avoided.

The balloon is inserted into the uterus by use of ultrasound to visualize its position in the uterus and filled with warm sterile water warm saline (this has a risk of crystallization) until the distended balloon was visible at the lower internal cervical os or until it was palpable per abdomen and surrounded by a well-contracted uterus the balloon is then supported at the vagina by use of sterile gauze or sterile pad.

This is a non-inversive and conservative procedure.

Types of uterine balloon tamponade

There are several types;

SENGSTAKEN BLAKEMORE TUBE.

This is a three-way catheter balloon used to minimize or arrest bleeding it’s easy to use and does not require specialization use of a 60 – 80 cc syringe to inflate the balloon. Then warm sterile water is inflated into the balloon a greater than 500 MLS of fluid can be used depending on the size and contraction of the uterus, it’s made of pure latex and hence expensive the main disadvantage of this method is, it’s an oesophagal catheter hence not designed for the uterus making it hard to occupy the shape of the uterus fully.

HYDROSTATIC CONDOM CATHETER

In this case, a normal condom can be used to arrest bleeding, it’s cheap and readily available. Similarly does not require specialization to be used. A normal catheter is inserted into the condom and fastened by the use of a rubber to strongly hold the catheter. Up To 150 Mls of warm saline is then used to hold the uterus preventing the bleeding.

There are disadvantages to this method ;

• it can easily burst.

• It does not completely hold the uterus, especially a uterus that is immediately postpartum

• Bleeding can still occur in the unballooned area and accumulate in the area

• Even though one or more condoms can be used, it does not completely arrest bleeding

• Increased risk of dropping as it has less fluid hence less support

Uterine packing

This is the use of several gauzes to arrest bleeding by putting pressure on the bleeder. In this case, sterile gauze is packed into the uterus by applying pressure this method though commonly used is the most dangerous of all methods below are some of its disadvantages;

• Requires experience in order to be tightly packaged adequately.. as one requires speed and small hands for effective packaging

• Delay in recognizing continual haemorrhage

• The success of the procedure is not known immediately

• The tightness of the pack is difficult to determine

• Can cause trauma during the packaging as it requires speed and infection as bleeding can continue

• It’s not effective as it may become loose once all the gauze are soaked with blood

• Removing the pack may be difficult as contraction will continue to occur hence may require dilation to be removed

Rusch hydrostatic urological balloon

Is a 2-way catheter. A 60 Mls bladder syringe is used to inflate the catheter. It holds a maximum of 500 Mls the procedure of insertion is similar to that of the SENGSTAKEN BLAKEMORE TUBE.

Bakri balloon

This is an SOS Bakri tamponade (cook gynae/ obs ) it’s 100%silicon

Using ultrasound, it’s inserted into the uterus ensuring the deflated balloon settles in the internal cervical os. During the caesarian section, the balloon can be inserted through the incision site, and the inflation part pulled through the cervical os into the vagina with the assistant’s help, ensuring the deflected balloon settles in the uterus. It’s then sutured carefully ensuring you do not puncture the deflected balloon. Then iodine packed cause or prophylactic gauze is put in place to ensure support of the balloon in site iodine/prophylaxis helps prevent infection.

The only disadvantage of this method it’s expensive and hence not affordable.

Foley catheter

Care and management of a uterine tamponade

It should be managed in the ICU where close monitoring of vital signs occurs, as fluid input and output monitoring.

Monitor fundal height and vaginal blood loss.

Continued oxytocin infusion to help keep the contraction for over 24 hours to help in maximum contraction of the uterus.

Broad-spectrum prophylactic antibiotics to minimize the onset of sepsis/infection.

The mean time to balloon the uterus or package is a minimum of 8 hours and a maximum of 48 hours to completely reduce the bleeding.

A graduated deflection has used this means to deflect do not withdraw the entire fluid once. Instead, withdraw about 10 -20 Mls of fluid over a longer period of time to prevent the dropping of the balloon.

APGAR Score