628: Comparison of Celox and Bakri balloon in management of primary atonic postpartum hemorrhage

Abstract

OBJECTIVE: Postpartum hemorrhage is a leading cause of maternal death in developing countries. Mechanical compression techniques as bakri balloon and the recently introduced chitosan gauze (celox) were used in the management of primary atonic postpartum hemorrhage in cases where medical uterotonic agents failed. This study was designed to show the effectiveness of intrauterine insertion of celox in comparison to the standard application of the Bakri Balloon. STUDY DESIGN: Un-blinded randomized parallel prospective study. Primary endpoint was any need for further surgical interventions (e.g. peripartum hysterectomy) as a failure of the mechanical method. Secondary endpoints (e.g. post insertion fever, admission to the intensive care unit) were also recorded. RESULTS: Preliminary data showed failure rate which lead to peripartum hysterectomies were 9.7 % (3/31) in the celox group compared to 40 % (12/30) in the bakri balloon group. Low grade fever (38-38.5 C) was recorded in 19.35 % (6/31) in the celox group compared with none in the bakri balloon group. Admission to the intensive care unit (ICU) was 41.9 % (13/31) (average stay 5 days) in the celox group compared to 33.3 % (10/30) (average stay 7 days) in the bakri balloon group. CONCLUSION: Celox appears to be a potentially effective method in the management of atonic PPH. It further is inexpensive, easy to use and has well manageable side effects compared to the standard intrauterine bakri balloon.

Effectiveness of uterine tamponade devices for refractory postpartum haemorrhage after vaginal birth: a systematic review

“…We found very few studies reporting the effect of UBT in atonic refractory PPH after vaginal delivery. We excluded 13 analytical studies because outcomes were measured in all births, 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 without disaggregating data according to the mode of delivery (Table S4 ), with one‐quarter to one‐half of the included cases ending in caesarean sections. Six studies were excluded due to: insufficient data, 39 , 40 involved women having a caesarean section, 41 the intervention being administered as part of a package, 42 UBT being administered as a first‐line treatment for PPH, 43 the outcomes reported differing from the prioritised outcomes in this systematic review 44 , 45 , 46 or involving the comparison of two different types of UBT.…”