“Tamponade Test” in the Management of Massive Postpartum Hemorrhage: The Use of the Rüsch Balloon

Introduction: Postpartum hemorrhage (PPH), leading cause of maternal death worldwide accounts for 30% of cases of global maternal mortality. PPH is largely preventable and prevention depends on timely medical intervention. Failure to control bleeding with medical conservative treatment prompts surgical exploration, which might even require hysterectomy. Alternative procedures should be considered when medical interventions have not been effective and before considering surgical options. Objective: Evaluation of the ef¿ cacy of urologic hydrostatic balloon catheter (Rusch catheter) use as a tamponade test, for severe PPH not controlled by medical measures. Methods: prospective non randomized controlled trial. We enrolled 6881 women who delivered in our Obstetric Department from 2001 to 2004 among which we identi¿ ed 120 cases of severe PPH. Patients were managed according to our current protocols. The 20 patients with uterine atony in whom medical treatment failed, were divided into 2 groups of 10 patients each. In Group A physicians weren’t able to use the tamponade test and in group B they had been trained to its use. Results: Group A: 3 patients had hysterectomy and 2 had B-lynch suture; they had more blood loss and more blood transfusions. Group B: all patients had bleeding stopped within 30 minutes and no patient needed any surgical intervention(p 0.033). The length of hospital admission was signi¿ cantly shorter in group B (p 0.0313). The haematologic complications (DIC) and the number of infections (pyrexia with T > or = 38° C) were comparable in both groups. Conclusions: Rüsch catheter used as tamponade test can control severe intractable PPH quickly and effectively, is simple to use, requires short time for application, it is cost-effective, safe and can avoid highly traumatic surgical intervention to many patients. Tamponade techniques should become an important skill of any obstetrician and an integral part of all obstetric emergency protocols: after this study all doctors in our department have been trained to use Rüsch catheter. After failure of medical treatment, and before proceeding to any surgical intervention either conservative or demolitive, attempting to stop bleeding via tamponade test is a reasonable option for PPH management after excluding retained tissue and traumatic causes of haemorrhage