Mechanical Procedures for PPH Management
Mechanical procedures used to treat atonic and non-atonic PPH include uterine massage, uterine packing and tamponade. WHO and FIGO strongly recommend the use of uterine massage for treatment of PPH immediately upon diagnosis.[6,27] Uterine packing is no longer recommended by the WHO due to concerns around potential harms. The WHO does recommend intrauterine balloon tamponade (IUB) (Figure 2) for atonic PPH unresponsive to uterotonics or when uterotonics are unavailable. IUB placement may reduce the need for invasive procedures; however, the evidence base is solely comprised of case-reports. Uterine balloons such as the Sengstaken tube, Bakri and Rüsch balloons are available in higher-resource countries but are prohibitively expensive for use in low-resource areas. Concerns around increased infection rates with IUB use are not supported by the literature. Intra-vaginal tamponade has been suggested for management of vaginal lacerations, but this has not been adequately explored. IUB also serves as a diagnostic tool to indicate whether laparotomy is required. Finally, use of IUB in conjunction with B-lynch or other compression sutures is a technique referred to as the 'uterine sandwich'; this joint method has been successful at avoiding hysterectomy in all reported cases with no postpartum morbidity and warrants further exploration. Chemical tamponade agents are also being explored for PPH.
Expert Rev of Obstet Gynecol. 2013;8(6):525-537. © 2013 Expert Reviews Ltd.