Published Paper Details:

Postpartum haemorrhage is any amount of bleeding from or into genital tract following birth of the baby up to the end of puerperium which adversely affects the general condition of the patient evidenced by rise in pulse rate and falling blood pressure. Postpartum haemorrhage is a major complication of delivery world wide as well as in Bangladesh. It is also a leading factor in maternal mortality and morbidity all over the world. It has been estimated that more than 125 thousand women die of PPH. In Bangladesh it contributes 26% of maternal deaths. However the present study has conducted to observe the efficacy of hydrostatic ballooning by condom, as an intrauterine tamponade in controlling PPH, where medical treatment fails, to find out safety and complication, to evaluate the morbidities after the procedure, to identify the risk factors cost effectiveness of the procedure and to evaluate the overall outcome of PPH cases after use of intrauterine balloon tamponade. The study was a prospective study. The study was conducted at department of Obstetrics and Gynaecology, Kumudini Women Medical College and Hospital at Tangail in Bangladesh. Fifty consecutive cases were being drawn from the admitted patients having PPH, after delivery. Under aseptic precautions a sterile rubber catheter was inserted within the condom and tied near the mouth of the condom by a silk thread. Urinary bladder was kept empty by indwelling Foley's catheter. After putting the patient in the lithotomic position, the condom was inserted within the uterine cavity. Inner end of the catheter remained within the Condom. Outer end of the catheter was connected with a saline set and the condom was inflated with 250-500mL of running normal saline till resistant to flow developed. Bleeding was observed, and when it was reduced considerably, further inflation was stopped and outer end of the catheter was folded and tied with thread. Uterine contraction was maintained by oxytocin drip for at least 6 hours after the procedure. The uterine condom was kept tight in position by ribbon gauze pack sterile sanitary pad or another inflated condom placed in the vagina. The condom catheter was kept for 24-48 hours depending upon the initial intensity of blood loss and then it was deflated gradually over (10-15 minutes) and removed. Patient was kept under triple antibiotic coverage (amoxicillin {500mg every 6 hrs} + metronidazole {500mg every 8 hrs} + gentamicin {80mg every 8 hrs}) administered intravenously for 2 days followed by oral 5 days. A questionnaire was used to collect information on age, parity, gestational weeks, antenatal care, mode of delivery, neonatal outcome, interval between delivery and PPH, time interval of onset of PPH and introduction of condom, duration of retaining condom in situ, place of occurrence of PPH, other associated complicating factors for PPH, hospital stay, blood transfusion and outcome PPH. Sample was selected as consecutive convenient sampling interview was taken from patient or her attendance that was available at that time. Antenatal, postnatal details and clinical examination findings were recorded. Medical treatment, interventional procedure and outcome recorded. Postpartum hemorrhage is an obstetric emergency. It becomes life threatening when it occurs in helpless women delivering at remote area/home. Uterine inertia, retained placenta with morbid adhesion is to be the major cause of postpartum hemorrhage along with mismanaged third stage of labour, Identification of the risk factors for developing PPH during the antenatal checkup, labour conducted by skilled birth attendant reduces the frequency of PPH. Immediate transfer of PPH cases to a health center where blood transfusion and operative facilities are available in short possible time is recommended. Hydrostatic method for control of obstetric haemorrhage is simple, safe, highly effective and economic. It can be used in developing country as well as developed for controlled of hamorrhage. Health providers involved in safe delivery practice including the paramedics can be easily trained in this procedure and can reduce maternal mortality to a great extent. If a readymade device with condom and plain rubber catheter can be made available in sterile packs (which should be cost effective) it would have been more applicable in all levels of health sectors. It is recommended to make large control trail of this type of study to control PPH to make this packing technique more acceptable and evidenced based thereby contributing to the safe delivery and safe motherhood programs of this country.