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 a uterine balloon tamponade. A uterine balloon tamponade prevents postpartum hemorrhage 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 on 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 hemorrhage 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 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.
Anesthesia Should 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. Uterotonics drugs such as oxytocin, misoprostol or tranxemic 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 hemoglobin.
There must be a functional operating theater which is accessible and functional. This is helpful incase 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 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 buy use of an ultrasound to visualize it’s 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.
Tis 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 size and contraction of the uterus, it’s made of pure latex hence expensive the main disadvantage of this method is, it’s an esophageal 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 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 accumulating 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
This is use of several gauzes to arrest bleeding by putting pressure on the bleeder. In this case, sterile gauze is packed into the uterus applying pressure this method though commonly used is the most dangerous of all methods below are some of it’s disadvantages;
- Requires experience in order to be tightly packaged adequately.. as one requires speed, and small hands for effective packaging
- Delay in recognizing continual hemorrhage
- 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 gauzes are soaked with blood
- Removing the pack maybe 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 SENGSTAKEN BLAKEMORE TUBE.
This is an SOS bakri tamponade (cook gynae/ obs ) it’s 100%silicon
Here using an ultrasound, it’s inserted into the uterus ensuring the deflated balloon settles in the internal cervical os. During 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 help of the assistant, ensure 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 hence not affordable.
Care and management of a uterine tamponade
It should be managed in ICU where close monitoring of vital signs occurs, fluid input and output monitoring.
Monitor fundal height and vaginal blood loss.
Continued oxytocin infusion to help keep 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 is 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 dropping of the balloon.