Advances in the Treatment of Postpartum Hemorrhage

Alison M El Ayadi; Nuriya Robinson; Stacie Geller; Suellen Miller


Expert Rev of Obstet Gynecol. 2013;8(6):525-537. 

In This Article

Mechanical Procedures for PPH Management

Mechanical procedures used to treat atonic and non-atonic PPH include uterine massage, uterine packing and tamponade.[6] 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.[6] The WHO does recommend intrauterine balloon tamponade (IUB) (Figure 2) for atonic PPH unresponsive to uterotonics or when uterotonics are unavailable.[6] IUB placement may reduce the need for invasive procedures; however, the evidence base is solely comprised of case-reports.[55] 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.[56] Intra-vaginal tamponade has been suggested for management of vaginal lacerations, but this has not been adequately explored.[57] IUB also serves as a diagnostic tool to indicate whether laparotomy is required.[58] 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.[59] Chemical tamponade agents are also being explored for PPH.[60]

Figure 2.

Intrauterine balloon tamponade.