Balloon Internal Uterine Tamponade: Experience with 39 Patients from a Single Institution

During the past several years, a number of new and simple techniques have been developed in the attempt to avoid major surgical procedures for treatment of postpartum hemorrhage (PPH). In addition, a variety of surgical and radiological options have been pro- posed to avoid hysterectomy. Unfortunately, a suitable conservative technique is still lacking for all situations1, and it is well recognized that all proposed options have risks as well as advantages. A practice bulletin from the American College of Obstetricians and Gynecologists (ACOG) suggests that tamponade of the uterus can be effective in decreasing hemorrhage secondary to uter- ine atony, and that procedures such as uterine artery ligation or B-Lynch suture may be used to obviate the need for hysterectomy. In general, four types of procedures can summarize all the conservative interventions in PPH: balloon tamponade, compression sutures, arterial embolization and pelvic devascularization. Among these, the uterine balloon tamponade has the advantage of simplicity and safety so that it can be easily carried out by doctors with minimal training and/or experience. Of interest, balloon tamponade has been used to control hemor- rhage in other obstetric conditions in which bleeding is of a serious nature, for example, following first- and second-trimester termination of pregnancy cervical pregnancy as well as to control PPH from vaginal lacerations.