Efficacy of Intrauterine Balloon Tamponade by 24-French Foley Catheter in Prevention of Postpartum Hemorrhage

Abstract

Background: Postpartum hemorrhage (PPH), is one of the most common causes of maternal mortality as well as morbidity worldwide. Around 88% of maternal deaths occur in the first 4 hours of delivery. So, the majority is the consequence of events in the third stage of labor. Most cases of primary PPH are caused by atonic uterus often due to prolonged labor, pre-eclampsia, or past history of PPH. Management of PPH involves a stepwise approach from medical to surgical management like laparotomy for systemic devascularization, uterine compression sutures, or peripartum hysterectomy. In 1983, Goldrath published that uterine tamponade can be possible by insufflating a Foley catheter in the uterus. Commercially available catheters such as Sengstaken Blackmore tube, Rusch urological catheter, and Bakri balloon are commonly used; however, their cost is the limiting factor for the regions of less privilege. Hence, this study is planned to evaluate the efficacy of 24-French Foley catheter tamponade in atonic PPH, after the failure of medical management, which is easily available, economical, and also quantifies blood loss. Methods: It is a prospective study. The subjects were PPH patients who failed to respond to medical management and were hemodynamically stable. Intrauterine 24-French Foley catheter was applied. The vital parameters were monitored. Monitoring for vaginal bleeding was done. The Foley catheter was kept for 24 hours. Results: Atonic PPH was there in 961 subjects. Intrauterine balloon tamponade by 24-French Foley catheter was applied to 800 patients. The duration of the study was June 2014 to May 2020 in Gadag Institute of Medical Sciences, Gadag, Karnataka. It was effective in 766 (95.75%) subjects. Around 34 subjects were in need of surgical management. Hence this alternative simple intervention method decreased many surgical interventions and respective morbidity. Conclusions: The intrauterine balloon tamponade by 24-French Foley catheter is the most effective, quite simple economical technique for preventing blood loss in atonic PPH.