Management of PPH

Condom Temponade
- Sayebas Method

Prof. Sayeba Akhter

FCPS(BD), DRH(UK),
FICMCH(IN), FCPS(PAC),
FRCOG(UK), FIAOG(IN)

MAMMS Institute of Fistula

and Womens Health
Arjumand Banu
Begum was
born in Agra in
1593, into a
familyof Persian
nobility, as a
daughter of
Abdul Hasan As
af Khan
They were married in 1612 AD
Mumtaz died in
1631 AD, due to
PPH, while giving
birth to their
fourteenth child.
 Apparently after
Mumtazs death,
Shah Jahan went
into secluded
mourning for a year.

Then started
establishing
Taj Mahal which
took more than 22
years to complete.
PPH in Maternal mortality and morbidity

PPH affects approximately 2% of all women who give

birth: it is associated not only with nearly one quarter
of all maternal deaths globally but is also the leading
cause of maternal mortality in most low-income
countries. PPH is a significant contributor to severe
maternal morbidity and long-term disability as well.

World Health Organization multicountry survey on maternal and newborn health. Geneva:
WHO; 2012
 PPH Data
In low-resource countries, Postpartum Hemorrhage (PPH) is the leading
cause of maternal mortality

> 30% of maternal deaths - PPH

Maternal death from PPH in developing countries - 1 per 1000 deliveries

Most common cause of PPH - Uterine atony

-
- 79% of all PPH
 The management of uterine atony is well
known and based on international
guidelines

First-line treatment Second-line treatment

Intrauterine balloon
Immediate uterine
tamponade
massage
Surgical interventions
with artery ligation
Administration of Artery embolization
uterotonic drugs Hysterectomy
World health Organization (2009) WHO Guidelines for the management of postpartum
haemorrhage and retained placenta. Geneva.
 Objectives the presnetation

Brief description of by different bolloon

Tamponade for PPH control
To enlighten the participant about the
simple, cost-effective, patient and user
friendly Sayebas method of PPH control.
To encourage them to use it if they found it
effective.
Causes of PPH

Uterine atony is the most common cause of

PPH, but genital tract trauma (i.e. vaginal or
cervical lacerations), uterine rupture, retained
placental tissue, or maternal coagulation
disorders may also result in PPH.
Treatment of PPH
PPH is diagnosed
ABC management
Uterotonics
Balloon Tamponade
Surgical intervention

B-Lynch suture
Systematic devascularization
Uterine artery embolization
Hysterectomy
Balloon Tamponade for PPH control

Snags-Taken Blackmore Tube

Rusch Balloon catheter
B-Cath
Bakri Balloon
Condom Catheter
Snags-Taken Blackmore tube
Rusch Balloon
B- Cath

But is expensive for developing world

Bakri Balloon
Bakri Balloon

But is Expensive for developing world

Sayebas Condom Tamponade
Sayebas Condom Tamponade
Practical Problem: Balloon
Migration
Prevention of balloon migration
Sayebas Method

Condom Temponade
technique for the
Conservative management
of PPH
Brief description of the method

A condom is inflated with isotonic saline/air

through a rubber catheter, and is used to
create tamponade within the uterus for
stoppage of massive PPH, when other
conservative methods failed.
The probable mechanism of action

The intrauterine balloon is believed to act by

exerting in inward-to-outward pressure that is
greater than the systemic arterial pressure to
prevent continual bleeding.
An alternative mechanism of action has been
proposed, which involves the hydrostatic
pressure effect of the balloon on the uterine
arteries.
Logistics needed

Instruments and logistics needed for condom

catheter application by Sayebas method- all FDA
approved
 Procedure

Condom tied over catheter by thread or clip

Procedure

Cervical lips are hold by sponge forceps

Procedure

Fitted condom is inserted into uterus

 Procedure

The mouth of cervix and vagina is then packed by

ribbon gauge pack or sterile sanitary pads to prevent
slippage of condom from the uterine cavity
Procedure

The distal end of rubber catheter is

connected with saline set
Procedure

Vagina packed & catheter connected with saline set

& condom is inflating
 Procedure

The regulator is opened up fully for rapid flow of saline into

the condom to inflate it within uterine cavity by 250-500 ml
of saline. In severe atony even 1500ml of saline may be
needed and can be introduced without any harm.
Procedure

Inflation of condom is shown

Procedure

Inflated condom producing distention of the

uterus and thereby compresses sinuses
Procedure

When saline stops going, the saline bag is

compressed. When resistance can be felt it
indicates tamponade has produced.
Procedure

When Tamponade formed, catheter folded & strapped

Procedure

When bleeding stops, it indicates

haemostasis has achieved ie.
tamponade test is positive.
The regulator of saline set is closed
and bleeding is observed.
In most of the cases bleeding stops
within 0-15 minutes.
Procedure

Vulval pad is applied tightly or the labia is stitched

together
Procedure

The vital signs and per vaginal bleeding need

to be monitored continuously.
I/V saline with 20 units of oxytocin has to be
continued for at least 6 hours to maintain the
uterine contraction.
The condom catheter is kept for 24 hours. If
still, bleeding is observed, catheter can be kept
for 48 hours.
Parentral antibiotic to be given at least for 72
hours
Procedure

If no more bleeding (which is our experience) the suture

is cut and catheter is deflated by draining the saline.
Deflation should be done gradually and stepwise
Procedure

The pack and condom catheter is removed

and vital signs and per vaginal bleeding is
continuously monitored
Evidence: International Journal of
Gynaecology and Obstetrics (2005)
90, 134-135
Characteristics No %
Type of PPH
Primary 19 82.60
Secondary 4 17.40

Mode of delivery
Spontaneous vaginal delivery 14 61
Instrumental delivery 3 13
LSCS 6 26

Cause of PPH
Atonicity 20 87.30
Placenta praevia and morbid adhesion 3 12.70
 Contd..

Characteristics No %
Time required to control PPH
0-15 min 23 100

Duration of retention of catheter

24 h 7 30.40
36 h 8 34.78
48 h 8 34.78

PPH Postpartum hemorrhage

LSCS Lower segment cesarean section
Advantages of condom uterine
temponade
Materials: All are easily available
everywhere, even in rural area
Cheap: Cost, balloon catheter, condom &
rubber Catheter ----20p (less than 10 taka)
Simple & Effective method
Patient can be referred with condom
temponade from community or lower
center to higher Centre
Can avoid more invasive methods,
including hysterectomy
Challenges

Condom can slip and lie in the

vagina: need careful packing
Some training is required:
learning curve is very short
Infection prevention practice is
also very important
Other uses of condom

To cover the TVS probe

Over the mould /foam to dilate vagina after
vaginoplasty
To stop intraperitoneal bleeding
Condom in arresting intraperitoneal
bleeding: Our experience

Bleeding from the bed of ectopic

abdominal pregnancy
Uncontrolled peroperative bleeding in a
case of malignant ovarian tumour with
extensive metastasis
Intraperitoneal bleeding in a case of
ruptured chocolate cyst and extensive
pelvic endometriosis
 Conclusion
For long we are trying to find out the
different weapons to fight against MD

Condom uterine temponade is one of the

very simple, cheap and effective weapons

I am greatful to the organizer of PPH

Congress 2004 and 2006 for selecting the
topics for presentation in the congress,
which help in dissemination of the device in
low income countries of Africa and Asia
Conclusion
contd..
It opens an era for the researcher
- Further exploration
- More scientific analysis of
- Future innovation
My salute to the person who first invent
condom
It has saved life and health of many mother
Also life and health of many more children
who would lost their mother at birth