Comparison between the effectiveness of Uterine Gauze Packing and Uterine Balloon Tamponade in the management of postpartum haemorrhage (PPH) during caesarean section: A prospective study

Dr. Manvee Kaushal; Dr. Rekha Jakhar

Volume : IX, Issue : II, February - 2020

Comparison between the effectiveness of Uterine Gauze Packing and Uterine Balloon Tamponade in the management of postpartum haemorrhage (PPH) during caesarean section: A prospective study

Dr. Manvee Kaushal, Dr. Rekha Jakhar

Abstract :

Background: Post–partum haemorrhage (PPH) is major cause of maternal mortality and morbidity in the developing world. Different options for the management of PPH have been in use including use of oxytocin, prostaglandins, ligation or angiographic embolization of uterine/internal iliac arteries & hysterectomy. Conservative surgical measures such as Uterine balloon tamponade (UBT) and Uterine gauze packing (UGP) were introduced to avoid hysterectomy as it is associated with major complications & sterility. Uterine packing was questioned & criticized because of the potential risk of postpartum infection, uterine trauma, and ineffective packing. The procedure has regained interest in its usage as being simple, safe, quick, cheap, and requiring no special equipment & has undergone several modifications in recent years. Objective: To compare the effectiveness of Uterine Gauze Packing (UGP) vs Uterine Balloon Tamponade (UBT) in the management of post–partum haemorrhage during c–section. Place & Duration: Our study was performed over 6–months in the Department of Obstetrics & Gynaecology of Umaid Hospital, Dr. S.N. Medical College, Jodhpur. Methods: It was a prospective interventional study of all the cases having primary PPH delivered via caesarean section in which UGP/UBT was used as the second–line treatment for PPH, after failure of initial conventional measures to stop bleeding. Success was considered as having no requirement for either a further therapy or hysterectomy for postpartum haemorrhage. Patients having PPH due to genital tract trauma and coagulation abnormalities were excluded. Result: The included PPH patients were subdivided further into two groups, in which UGP or UBT was used as second–line treatment for women undergoing caesarean sections. Of all patients initially treated by basic managements for expected PPH, 77 cases underwent UGP & 23 UBT as the second–line therapies to stop persistent bleeding. The rates of success for UGP & UBT were 90.91% and 95.65%, respectively. The respective rates of puerperal morbidity were 6.49% and 4.35%, with risk ratio of 1.49 (95% CI: 0.18, 12.15). Conclusion: In our study, no significant difference is observed in the rates of success for UGP vs UBT. Although our results indicate higher rate of puerperal morbidity, UGP could be included in the treatment modalities of PPH together with the provision of suitable training & maintenance of proper asepsis, especially in resource–poor settings because of its low–cost and easy availability.