COMPARATIVE STUDY OF UTERINE GAUZE PACKAGING AND SANGESTAKEN BLACKMORE ESOPHAGEAL CATHETER FOR THE MANAGEMENT OF PPH

Aims and Objectives: The present study was conducted with the aim to assess and comparatively evaluate the safety and effectiveness of Sangestaken Blackmore oesophageal catheter with uterine gauze packaging for the management of PPH. Methods and Materials: The study was conducted in 100 selected cases of PPH divided in two groups of 50 cases each who did not respond to standard medical therapy. The procedures were carried out in OT using minimal analgesia or regional anaesthesia. In uterine packing group. The packing was done with a variable length of sterile ribbon gauze soaked in povidine iodine solution. Vaginal route was used for women who develop PPH after vaginal birth where as packing was done through uterine incision in case of cesarean section delivery tip of the ribbon gauze was observed for soakage and free trickle of blood over 5-10 minutes. In case the tip remained dry packing was considered successful where as if gauze was readily soaked with blood the procedure was considered failure one. In second group SBE catheter was inserted via the cervix or through cesarean section wound intraoperatively at least 15 cm of the catheter was inserted into the uterine cavity and the balloon was inflated with 300ml warm normal saline and then palpated per abdomen upper vagina was firmly packed to avoid expulsion of the tube when there was no or minimal bleeding the procedure was considered successful. Results: The success rate in SBMEC was higher 94% as compared to 78% in case of uterine packing group (p = 0.021). The removal of catheter was easy and there is no chance of concealed haemorhage and infection as compared to the uterine packaging group. Conclusion: Sangestaken blackmore balloon temponade has the potential of being a life saving procedure and should be an integral part of obstetric emergency protocols for massive PPH. Uterine packing is technically difficult and time consuming and there is delay in recognizing continuous haemorrhage and there is a potential risk of trauma and infection and needs expertise for insertion.