Condom pressure for atonic PPH

 

Condom pressure for atonic PPH :  Atonic PPH : Conservative Tr :--Any member have ever used  condom for balloon tamponade of bleeding lower uterine segment.
Primi with twins (both breech) with preeclampsia was taken up for cesarean on Saturday morning. Uneventful cesarean, slightly increased bleeding intra op. Closed the uterus and abdomen. Vaginal toilet showed persistent bleeding from LUS despite a well contracted upper segment. We packed the vagina with roller gauze, hoping that the compression of the lower segment between the pack and the upper segment will stop the bleeding.  LUS bleed is fairly common

 

 After four hours when we removed the pack we found big clots in the vagina. The bleeding was coming from the the lower segment. That's when I considered using condom for balloon tamponade to avoid a possible obstetric hysterectomy.

Condom is to be  tied it over a 22 Fr Foley's, inserted the system in the LUS, first inflated the Foley balloon and then pushed about 250 ml of saline into the condom using a 50 ml syringe. Or else one can fill up the condom with running NS from a bottle(quicker response) .

 The condom tended to bulge out through the os and we held it in place using a roller pack   or  Instead of gauze vaginal pack, one may  use 2 sponge forceps holding both cervical lips to occlude slippage of condom through dilated OS.or  can simply use silk to tie firm knots and fix the Foleys inside the condom. It is possible to tie such knots without occluding the catheter and definitely after instilling saline we have to clamp or tie up the channel to prevent leakage (as in the case of extra amniotic instillation we used to clamp or tie up the outer end of the catheter )

 On Sunday morning, we removed the of pack and then removed condom and the Foley. No bleeding. continuous oxytocin infusion to keep the uterus contracting over the condom used for tamponade usually gives good results. 
Inj Methergin too can be added to the drip (making it syntometrine) as it has a good effect on lower segment bleeding since it causes tetanic contraction of both upper and lower segment unlike oxytocin which acts well on upper segment while causing receptive relaxation of lower segment (as in intra-partum augmentation).

 

Admittedly, A Bakri balloon would be a much more predictable device in this situation.

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For placenta previas many are using Bakri balloon for about one decade more than three years

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