Use of a condom to control massive postpartum hemorrhage.
OBJECTIVE
To evaluate the efficacy of a condom as a tamponade for intrauterine pressure to stop massive postpartum hemorrhage (PPH).


METHODS
This prospective study was done in the Obstetrics and Gynecology Department of Dhaka Medical College and Hospital, Bangladesh, between July 2001 and December 2002.


METHODS
During the study period, 152 cases of PPH were identified; 109 were managed medically; 20 were managed using the B-Lynch procedure, and 23 were managed using the condom catheter. Patients were selected for intervention with the condom catheter when PPH that occurred as a result of atonicity or morbid adhesion (accreta) could not be controlled by uterotonics or a surgical procedure. In patients who were in shock due to massive hemorrhage, a condom catheter was introduced immediately without prior medical management.


METHODS
With aseptic precautions, a sterile rubber catheter fitted with a condom was introduced into the uterus. The condom was inflated with 250-500 mL normal saline, according to need. The condom catheter was kept for 24-48 hours, depending upon the initial intensity of blood loss, and gradually deflated when bleeding ceased.


METHODS
(1) Ability of condom catheter to stop bleeding; (2) time required to stop bleeding after the tamponade was applied; (3) subsequent morbidity in terms of severe infection, despite use of prophylactic antibiotics.


RESULTS
In all 23 cases in which the condom catheter was used, bleeding stopped within 15 minutes. No patient needed further intervention. No patient went into irreversible shock. There was no intrauterine infection as documented by clinical signs and symptoms and culture and sensitivity of high vaginal swab.


CONCLUSIONS
The hydrostatic condom catheter can control PPH quickly and effectively. It is simple to use, inexpensive, and safe. In developing countries where PPH remains a primary cause of maternal mortality, any healthcare provider involved in delivery may use this procedure for controlling massive PPH to save the lives of patients.
Department of Obstetrics and Gynecology, Dhaka Medical College and Hospital, Dhaka, Bangladesh.
Sayeba
S
Akhter
Mosammat Rashida
MR
Begum
Zakia
Z
Kabir
Maliha
M
Rashid
Tarafder Runa
TR
Laila
Fahmida
F
Zabeen
D000328:Adult; D021721:Balloon Occlusion; D002404:Catheterization / Q000295:instrumentation / Q000379:methods*; D017280:Condoms; D005260:Female; D006801:Humans; D006874:Hydrostatic Pressure; D009123:Muscle Hypotonia / Q000150:complications; D010921:Placenta Accreta / Q000150:complications; D006473:Postpartum Hemorrhage / Q000209:etiology / Q000628:therapy*; D011247:Pregnancy; D011446:Prospective Studies; D012771:Shock, Hemorrhagic / Q000209:etiology / Q000628:therapy; D014599:Uterus / Q000473:pathology