ABSTRACT
To describe the practice and efficacy of intrauterine balloon tamponade catheter in two obstetric units and to highlight uterine tamponade as an integral part of the management options of severe post partum hemorrhage in labour ward. Fourteen cases of severe post partum hemorrhage had persistent bleeding despite the available conservative measures. At this point, the Bakri balloon [Cook Medical] was inserted into the uterine cavity. The balloon was inflated with 300-500 ml of normal saline and left for a maximum of 24 hours, when it was gradually deflated. The procedure was covered by cefoxitin [Mefoxin] 1g three times daily for 48 hours. Simple descriptive statistics [mean, frequency and percentage] were used to describe the study variables. The mean age was 28 [21-35] years. Six patients were primigravidas [43%]. The causes of post partum hemorrhage were as follows: Six cases of uterine atony, six cases of placenta praevia accreta and two cases of fibroids. Eight cases followed cesarean section and six cases followed vaginal delivery. The average blood loss was 1.9 L [1.5-3.5 L]. In total, 59 units of whole blood, 45 units of FFP and 22 units of platelets were given. On average each patient received 4.2 units of blood, 3.2 units of Fresh frozen plasma and 1.6 units of platelets. Two cases had evidence of disseminated intravascular coagulation and received Factor VII [two doses each]. The balloon was inflated to an average of 420 ml of Normal Saline [300-500 ml] according to uterine capacity. In 12 cases [86%], the trial was successful and no further surgery was required. In two cases [14%] the trial failed and both of these women underwent hysterectomy. No cases of endometritis were reported in hospitalized patients or on follow up one week after discharge. Intrauterine balloon tamponade is a valid alternative to less conservative surgical procedures in managing women with post partum hemorrhage. It is easy, safe, and effective and preserves fertility. It should be an integral part of labour ward protocols for management of post partum hemorrhage. Suitable catheters should be available on the labour ward theatres
ABSTRACT
The aim of this study is to evaluate the efficacy, safety and side effects of intracervical Foley catheter balloon in comparison with intra vaginal prostaglandin pessaries in preinduction cervical ripening at term. This randomized prospective study was conducted in the maternity department at King Hussein Medical Centre and Prince Ali Bin Al-Hussein Hospital between July 2009 and July 2010. Four hundred and fourteen women who required induction of labor, with a Bishop score of less than or equal to 5 and met the inclusion criteria, were randomized into two groups: 204 women received prostaglandin E2 vaginal tablets [group I] and 210 women had an intracervical Foley catheter inserted, and the balloon inflated with 60 ml N/Saline [Group II]. The outcome measures were: mode of delivery, time interval between induction to delivery and maternal and neonatal adverse reactions. Age, parity and indications for induction of labor, were similar in both groups. In Group I, 63% achieved normal vaginal delivery compared to 61% in Group II [p= 0.8]. Cesarean section rate was 34% in both groups. The rest had instrumental delivery. The time interval between induction to delivery was longer in the Foley catheter group than PGE2, but not statistically significant [mean 22.6 h vs. 21.4 h; P= 0.3101]. The rate of oxytocin administration was more in Foley catheter group than Prostaglandin E2 [78.6% vs.65.7%; P= 0.018]. Uterine hyper stimulation was more in PGE2 group than Foley catheter 6 [3%] vs.1 [0.5%]; P= 0.0013]. The Apgar scores, neonatal birth weight and admission to neonatal intensive care unit showed no difference between the two groups. PGE2 vaginal tablets and Foley catheter are comparable in efficacy for induction of labor in women at term. However, Foley catheter has the advantage of being safe, simple, reversible and associated with fewer side effects