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UPDATE OF NEW TECHNOLOGIES TO TREAT POSTPARTUM HAEMORRHAGE. Presented by Dr. Sylvia Deganus. Presentation Outlines. The PPH Problem and Management Challenges The New Technologies Measuring Blood Loss Balloon Tamponade Anti-shock Garments New Intra –Operative Surgical Techniques
Dr. Sylvia Deganus
Courtesy Goudar, Eldavitch, Bellad, 2003
(They include weighing soaked clothes and pads, collection into pans etc., Acid haematin techniques, Spectrophometrictechnics and measuring plasma volume changes)
Goudar, Eldavitch, Bellad, 2003
$220 for two devices
$77 (quoted £50)
$250 per device
$200 per device
These commercially available devices are prohibitively expensive
Source: Georgiou C. Balloon tamponade in the management of postpartum haemorrhage: a review. BJOG 2009;116:748-757
A condom still saves lives even during Childbirth!
Developed in Bangladesh
by Ashkter and Team
The Condom /Catheters Unit
can be assembled in a few minutes and cost of components is ≤ U.S.$5
Inflate Condom with water till no further bleeding is occuring (usually about 300-500 mls )
Apply clamp to keep water within
Condom after inflation
1. Place condom over balloon end of Foleys catheter
2. Using suture / string tie lower end of condom snugly below level of the balloon as shown. Tie should be tight enough to prevent leakage of water but should not strangulate catheter and prevent inflow of water into condom. Check for leakage by inflating ballon with about 20cc water.
3. Using an aseptic technique place the condom end high into uterine cavity by digital manipulation or with aid of speculum and forceps
4. Inflate CT by connecting open/outlet end of catheter to giving set connected to infusion bag or use clean water with aid of large syringe. ( Will need to cut the giving set at level of yellow rubber to enable it fit into catheter)
5. Inflate condom with water or saline to about 300- 400 mls (or to amount at which no further bleeding is observed).
6. Clamp catheter when desired volume is achieved and bleeding is controlled.
7. Maintain In-situ for 6-12 hours if bleeding controlled and patient is stable.
8. Give Broad spectrum antibiotic cover
9. Continue to monitor patient closely, resuscitate and/or treat shock necessary
10. When patient is stable ( after 6 hours) slowly deflate condom by letting out 50 mls of water/saline every hour.
11. Re-inflate to previous level if bleeding reoccurs whilst deflating.
12. CT may be kept in place for up to 24 hours
13. If Bleeding is not controlled within 15 mins of initial insertion of CT abandon procedure and seek surgical intervention immediately.
When should we not use the balloon?
Key Issues: In expanding access of Balloon Tamponade to low-resource settings
A variety of new intra-operative techniques are now available to effectively control bleeding from the uterus: They either act to produce tamponade by compressing the uterus and apposing its anterior and posterior walls or to effectively reduce blood flow to the uterus. These techniques include:
Step 1: Using Absorbale arge suture.
B-Lynch Suture #2
Courtesy: Lynch BC, Coker A, Laval AH et al. The B_Lynch technique for control of Masive PPH,
An Alternative to Hysterectomy. Five Cases Reported. Br. J. Obstet Gynecol 1997, 104 327-376
Modifications of this procedure are also available:
Example Suture is “fixed” by taking bites through Myometrium at the fundus
A Straight needle is passed anterior to posterior and passed over fundus and ligated anteriorly.
Multiple square sutures are
Passed intramurally and tied at
Cho JH, Jun HS, Lee CN: Haemostatic Suturing Technique For uterine Bleeding during Cesarean Section delivery. Obstet Gynecol 200 0 96:129-131
Useful in Haemorrhage associated with Placenta praevia
There was no statistically significant difference between the four groups (P = 0.06).
Keeps woman alive during prolonged transportation to reach help (CEOC).
Two Zambia NASGsUsed 50+ Times
(Systematic reviews, RCT,
UTERINE MASSAGE / MORE OXYTOCICS
BIMANUAL COMPRESSION / AORTIC COMPRESSION /ANTI-SHOCK GARMENT
HYDROSTATIC CONDOM TAMPONADE
Image courtesy of defeatpoverty.com