Novel suction tube uterine tamponade for treating intractable postpartum haemorrhage: description of technique and report of three cases

Abstract

Uterine balloon tamponade (UBT) is widely used to treat postpartum haemorrhage (PPH). Randomised trials of UBT are scarce: those of improvised condom UBT in low‐resource settings found more harm than good. Uterine suction tamponade (UST) is more aligned with the physiological mechanism of uterine haemostasis (contraction), but purpose‐designed devices may be unaffordable or unavailable when needed. We describe a technique of UST using an inexpensive Levin suction catheter. Use of the described technique as a last resort in three cases of life‐threatening PPH resulted in prompt cessation of bleeding. We emphasise the need for randomised trials to confirm effectiveness.

Circular suture of the uterine serosa and myometrium layer around placental attachment site for refractory postpartum hemorrhage

“…Hemostasis efficacy was evaluated according to standards of clinical practice 23–25 . The hemostasis was treated as effective when vaginal bleeding ≤50 ml/h and bleeding significantly reduced or stopped.…”

“…21,22 Hemostasis efficacy was evaluated according to standards of clinical practice. [23][24][25] The hemostasis was treated as effective when vaginal bleeding ≤50 ml/h and bleeding significantly reduced or stopped. Intrauterine hemorrhage was decreased or stopped during cesarean section, and vital signs should be stable and urine volume be normal.…”

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

“…Similar to UBT, there are UST purpose-designed and improvised devices. 8,13 Why it is important to do this review…”

“…Such USTs could be considered a physiologically plausible alternative for the management of unresponsive PPH, as the mechanism of action mimics physiological uterine retraction. Similar to UBT, there are UST purpose‐designed and improvised devices 8,13 …”

“Suction Tube Uterine Tamponade” for treatment of refractory postpartum hemorrhage: Internal feasibility and acceptability pilot of a randomized clinical trial

“…We have identified a low‐cost, widely available soft plastic catheter (the Levin stomach tube) and performed a preliminary assessment of the functionality of “Suction Tube Uterine Tamponade” (STUT, awarded the JG Sciarra prize by IJGO in 2019) 19 . We reported three successful cases of the method used as a last resort in life‐threatening PPH 20 . To date, no complications have been reported in over 200 reported cases of UVT using a variety of suction devices.…”