Condom Uterine Tamponade A Revolutionary Invention to Control Postpartum Haemorrhage
Postpartum haemorrhage (PPH) is the most challenging situation faced by obstetricians. It remains the primary cause of maternal mortality in low & low-middle-income countries. In some South Asian countries, such as Bangladesh, many obstetrics patients were dying from excessive bleeding just after giving birth a few decades ago. Many of them had to undergo hysterectomy (a surgical procedure to remove the uterus), sacrificing the further opportunities of giving birth, just to prevent this uncontrolled bleeding. To overcome this situation, Dr. Sayeba Akhter invented a method of Condom Tamponade in 2000.
A Revolutionary Invention to Control Postpartum Haemorrhage
Bangladesh Medical College, Bangladesh *Corresponding authors: Mahfuza Anan, Bangladesh Medical College, Bangladesh, Email: Mahfuzaanan980@gmail.com
Opinion
A Revolutionary Invention to Control Postpartum Haemorrhage
Postpartum haemorrhage (PPH) is the most challenging situation faced by obstetricians. It remains the primary cause of maternal mortality in low & low-middle-income countries. In some South Asian countries, such as Bangladesh, many obstetrics patients were dying from excessive bleeding just after giving birth a few decades ago. Many of them had to undergo hysterectomy (a surgical procedure to remove the uterus), sacrificing the further opportunities of giving birth, just to prevent this uncontrolled bleeding. To overcome this situation, Dr. Sayeba Akhter invented a method of Condom Tamponade in 2000.
Dr. Sayeba Akhter, the then chair of the Gynaecology & Obstetrics department of Dhaka Medical College Hospital, used Condom Uterine Tamponade to control postpartum haemorrhage as well as to preserve the uterus. It is a cheap, safe, simple, highly effective & and easy-to-administer method of controlling postpartum haemorrhage while preserving the uterus. This approach is widely accepted as “Sayeba’s method of PPH control” in many developing countries like Bangladesh, India, Nepal and Sri Lanka. Dr. Sayeba Akhter received national awards for this revolutionary invention.
When medical treatments are not readily available or surgical removal of the uterus is required to control Opinion postpartum haemorrhage, a uterine tamponade is used as an alternative to surgical procedures. A good uterine packing technique makes a layer within the whole uterine cavity and occludes the blood vessels by putting pressure. So, bleeding is stopped within a few minutes and the uterus can be preserved.
History
A traumatic experience led her to discover this method. One day, two women died in front of her due to postpartum haemorrhage. Then she remembered the scene of village children playing with balloons. Then she exclaimed that we could stop bleeding by inserting the balloons filled with water into the uterus. The main step to stop bleeding is to apply pressure inside the uterine cavity. However, it is not possible to apply pressure during bleeding inside the uterus. The next day, she saw that the doctors had decided to remove the uterus to stop bleeding. She prevented them from doing so and made an effort to perform this new idea. That was the first attempt to use the “Condom Catheter Tamponade” & the bleeding stopped within 10 minutes. Dr. Sayeba Akhter then applied the same procedure to 24 women. All of them recovered successfully.
Requirements
- A catheter
- A saline infusion set
- A saline solution
- Few threads
Procedure
Here are the steps of inserting condom uterine tamponade:
After taking all aseptic precautions, a sterile rubber catheter is inserted within the condom & tied near the mouth of the condom by a silk thread.
The urinary bladder should be kept empty by using a Foley catheter.
The patient should lie in the lithotomy position & the condom is slowly introduced to the uterine cavity through the vagina.
The inner end of the catheter is kept within the condom.
The outer end of the catheter is tied with a saline set & the condom is inflated with 25-500ml of running normal saline.
Bleeding is observed. When it is greatly reduced, further inflation should be stopped and the outer end of the catheter is folded & tied with a silk thread.
After this procedure, uterine contractions are maintained by oxytocin drip for at least 6 hours.
This uterine condom tamponade is fixed in this position by using by ribbon gauze pack or another inflated condom into the vagina.
This condom catheter is kept for at least 24-48 hours and then gradually deflated over 10-15 minutes and removed from the uterus.
Patient should be kept under triple antimicrobial therapy-[Amoxicillin (500mg 6 hourly) + Metronidazole (500mg 8 hourly) + Gentamicin (80mg 8 hourly)] - administered intravenously for at least 7 days.
When any part of the body is cut, putting pressure on that area is the primary way to stop bleeding. Sayeba’s method works in this way. The entire apparatus costs almost 100 TK or 99 cents. It doesn’t require skilled clinical personnel to perform. So, this procedure can be easily applied in any health complex, even in rural areas. Therefore, we can believe that “Sayeba’s method of PPH control” can be the best alternative to the surgical procedures of controlling PPH [1].
Reference
1. Akhter S, Begum MR (2003) Use of a condom to control massive post-partum haemorrhage. MedGenMed: Medscape general medicine 5(3): 38.
References
-
Akhter S, Begum MR (2003) Use of a condom to control massive post-partum haemorrhage. MedGenMed: Medscape general medicine 5(3): 38.
- Management of Chronic Insertional Achilles Tendinopathy Using Flexor Hallucis Longus Tendon Transfer in Patients Over 50 Years of Age: A Four-Case Series Following the CARE Guidelines
- Application of Induced Pluripotent Stem Cells in Bone Tissue Engineering: Current Status and Prospects
- Surgical Management of Upper Thoracic Esophageal Squamous Cell Carcinoma with Concomitant Hypersplenism: Integration of Chai's Supra-Thoracic Apex Technique with Laparoscopic Splenectomy - A Technical Innovation Case Study with Systematic Review
- Evaluation of Masticatory Functional Efficiency of Stomatognathic System in Patients Undergoing Open Reduction Internal Fixation for Treatment of Pan-Facial Trauma: A Prospective Study
- Hepatic Abscess Secondary to Appendiceal Phlegmon an Unusual Complication of Appendiceal Phlegmon
- Report of Lumboperitoneal (LP) Shunt Procedure in Over Decades Experiences, Systematic Narrative Review