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Intrauterine Balloon Tamponade (PPH)

Intrauterine Balloon Tamponade (PPH) operating theatre - obstetric
IN REVIEWPENDING CLINICAL VERIFICATION
Indications
  • Atonic PPH refractory to uterotonics
  • Post-trauma bleeding after repair
  • Bridge during transfer
Consent points
  • Emergency consent documented
  • Failure -> surgery ladder explained
Equipment
  • Bakri/Rusch/Foley(+condom) kit, warm saline, infusion set, tape traction, catheter bag
  • Theatre conditions preferred
Anaesthesia
  • Existing epidural/GA ideal; can be done under analgesia in emergencies

Absolute contraindications: Ongoing surgical bleeding source (vessels/tears) · Infection unmanaged · Uterine malformation blocking placement

Preparation

  • Bladder empty; uterotonic maximised; blood running
Procedure steps
  1. Insert balloon above internal os US-guided when feasible
  2. Fill warm saline INCREMENTALLY until bleeding stops (150-500 mL typical)
  3. Document fill volume; apply modest traction tape
  4. Vaginal pack adjunct where device lacks stem
  5. Keep catheter draining bladder continuously
Troubleshooting:
  • Refills beyond ~500 mL without control = failure sign -> laparotomy promptly
  • Recurrent filling: reassess for missed trauma/coagulopathy BEFORE more volume
Complications & management
Device displacement

Traction+tape; reposition theatre if recurrent

Infection (leave <=24 h)

Single-dose antibiotic cover; timed removal with uterotonic standby

Postoperative care

  • Hourly bleeding observation x6
  • Remove 6-24 h with team ready for re-bleed

Admission & discharge

Care setting: Emergency admission; major bleeding may need theatre/critical care

Admission/discharge guidance checked 2026-10-18 against the linked sources. This is a clinical checklist for an individual decision, not an automatic discharge order.

Balloon tamponade requires monitored hospital care with rapid access to resuscitation and operative treatment. Stabilisation for interfacility transfer is a separate decision from discharge home.

When admission or continued hospital care is needed

  • Admit and treat ongoing heavy bleeding, abnormal haemodynamics, suspected retained tissue/infection or coagulopathy. Transfer to theatre/critical care according to bleeding and organ-support requirements.

When clinic, day care or home care may be suitable

  • Active PPH, shock or suspected secondary PPH with systemic illness is not suitable for routine outpatient management.

Before going home

  • The intrauterine haemorrhage balloon and any associated packing have been removed under the obstetric team’s monitored plan and bleeding reassessed. A uterine tamponade balloon is not a home-care device.
  • The bleeding source is controlled; uterine/perineal/wound assessment is satisfactory and there is no recurrent concerning loss.
  • Haemodynamics, consciousness, urine output, oral intake, mobility and pain control support home care. Review anaemia symptoms, Hb trend and any coagulopathy/organ injury; there is no single Hb value that alone certifies safe discharge.

Discharge medicines and treatment changes

  • Prescribe iron replacement when iron deficiency/anaemia is present, using a documented formulation, dose and response plan; assess whether IV treatment or transfusion is needed before discharge.
  • Uterotonics and TXA used for the acute event are not automatically continued at home. Reassess VTE prophylaxis after bleeding risk has fallen.
Medicine doses — use only when indicated

Use the medicines selected for this patient. Listed alternatives are not instructions to prescribe all of them together. Confirm the actual remaining course, pregnancy/postnatal context and monitoring plan.

Only for diagnosed postpartum iron-deficiency anaemia after bleeding is controlled.

Oral iron and folic acid — postpartum anaemia treatmentWHO / FIGO / ICM · 2025 consolidated recommendations, supportive care tablesummary checked
Dose120 mg ELEMENTAL iron plus 400 micrograms folic acid per day
RouteOral
FrequencyDaily; tailor administration for tolerance without accidentally changing the prescribed total
DurationWHO postpartum anaemia treatment: until Hb normalises. Then document any continuing preventive/repletion course and review; the preventive 6–12-week recommendation is a different indication.
PreparationUse the product’s ELEMENTAL iron content, not salt weight: two tablets each containing 60 mg elemental iron provide 120 mg. Check the combined-tablet folate separately. Separate iron from calcium by several hours and levothyroxine by 4–5 hours.
Max dose120 mg/day elemental iron in this WHO treatment schedule; do not add duplicate antenatal/OTC iron or overlap oral and IV courses without an explicit plan.
  • Indication: Diagnosed postpartum iron-deficiency anaemia after haemorrhage is controlled and outpatient oral treatment is suitable
  • The WHO 2025 supportive-care recommendation supplies the postpartum dose/endpoint. Preparation and response monitoring reuse the checked oral-iron reference; breastfeeding is compatible with indicated maternal supplementation.
Monitoring
  • Arrange Hb response review after 2–4 weeks, tolerance and adherence; investigate non-response or ongoing bleeding and reassess the replacement route.
  • Review the cause of anaemia and any coexisting B12/folate deficiency or haemoglobinopathy.
Contraindications: Iron overload or anaemia without iron deficiency; oral iron alone is inadequate for unstable bleeding or cardiovascular compromise.

Tests, pending results and their reviewer

  • Record quantified loss, procedures, transfusion and latest relevant CBC/coagulation/renal results; assign a reviewer/date for outstanding investigations.

Home care and counselling

  • Explain the cause and treatment, expected lochia, worsening-bleeding warnings, fatigue/feeding support and the future-birth haemorrhage plan. Offer a debrief and emotional support.

Follow-up: when and what to review

WhenAction / responsible service
Before leaving
Book anaemia/Hb response review and communicate any organ-injury or transfusion follow-up to the responsible team.
Early postnatal contacts and 6-week review
Review bleeding, recovery, mental health and the future-pregnancy plan; review sooner for symptoms or major anaemia.

Return urgently

  • Sudden/heavy or increasing bleeding, fainting, breathlessness, fever, offensive discharge or worsening abdominal pain require immediate assessment.

Open the complete discharge checklist →

Sources for this plan:
MSFcheckedNICE · NG194, recommendationscheckedIndia MoHFW / NHM · LaQshya district-hospital SOP, linked editioncheckedWHO · 2022 official recommendation summarycheckedWHOsummary checkedWHO / FIGO / ICM · 2025 consolidated recommendations, supportive care tablesummary checked
Follow-up: PPH recovery bundle; documentation audit · Sources: WHO / FIGO / ICM, MSF, NICE, India MoHFW / NHM, WHO, WHO, WHO / FIGO / ICM, RCOG, NICE
WHO / FIGO / ICM · Consolidated edition (supersedes fragmented prior guidance incl. 2012 PPH recs; incorporates 2017 TXA recs, 2018 uterotonics, 2023 blood-loss assessment/treatment bundle)summary checkedMSFcheckedNICE · NG194, recommendationscheckedIndia MoHFW / NHM · LaQshya district-hospital SOP, linked editioncheckedWHO · 2022 official recommendation summarycheckedWHOsummary checkedWHO / FIGO / ICM · 2025 consolidated recommendations, supportive care tablesummary checkedRCOG · Current public recovery informationcheckedNICE · CG50, recommendationschecked