Uterine Balloon Tamponade

A uterine balloon tamponade is a simple device made from common, low-cost materials that can stop post-partum hemorrhage due to a relaxed uterus. It’s inserted inside the uterus, filled with fluid and works by compressing the bleeding vessels. This video will show how to use a uterine balloon tamponade for postpartum hemorrhage.

This woman is bleeding heavily. Her uterus is not contracting even though you have massaged it, given her medicine to contract her uterus, and done bimanual compression. Tell the woman what you need to do and why. Ask for her consent. Then place a urinary catheter into her bladder. Do aortic compression as you prepare and insert a uterine balloon tamponade.

Have your supplies ready in a kit: a urinary catheter, sterile gloves, a condom, sterile string, a 60 milliliter syringe, an IV giving set, and a 500 milliliter bag of IV fluid. You will also need a ring forceps, and a sims speculum. Wash your hands and put on sterile gloves. Place the condom over the catheter. Then tie a string tightly around the end of the condom.

Let’s see that again close up: unroll the condom over the catheter until the condom is completely unrolled. Then, with a length of sterile string, securely tie the end of the condom. Place the speculum to visualize the cervix. Then insert the catheter with the condom through the cervix and high into the uterus. Some birth attendants use 2 condoms for extra security.

Connect the catheter to the IV giving set and run in 300 to 500 milliliters of IV fluid. As the condom fills with water it presses against the inside of the uterus where the bleeding is coming from. The pressure stops the bleeding. Inflate the condom until it is visible at the cervix. Now ‒ fold the catheter and clamp it to keep the fluid inside. Record how much fluid you have used, and the insertion time.

Mark the level of the uterine fundus. Monitor if the fundus rises beyond the mark. This is a sign of hidden bleeding. If bleeding is not controlled 15 minutes after inserting the balloon tamponade, keep the device in place and transport the woman for surgical care immediately. If bleeding is controlled, give oxytocin 20 units in 1 liter of IV fluid at 60 drops per minute. Also give the woman a single dose of antibiotics to prevent infection ‒ either 2 grams of ampicillin IV OR 1 gram of cefazolin IV.

Closely monitor the woman’s bleeding, her fundal height, and vital signs. After 6 hours and up to 24 hours, if the woman is stable – with no vaginal bleeding and her fundal height is at the same level – start to slowly remove the fluid from the balloon. Remove 200 milliliters every hour. If her bleeding starts again, refill the balloon. If there is no further vaginal bleeding 30 minutes after the balloon is flat, remove the balloon. Continue to monitor the woman for the next 6 hours.

Remember, have your supplies ready in a balloon tamponade kit. As the condom fills with water, it presses against the inside of the uterus and stops the bleeding. After 6 hours and up to 24 hours, if the woman is stable, begin to slowly remove the fluid.