Intrauterine Balloon Tamponade

The Bakri is commonly used in the United States to perform uterine balloon tamponade as it effectively stops hemorrhage in 77.5 to 88.8 percent of cases. The cost of a Bakri balloon is 250 USD, so it is unavailable in developing countries. A cheaper alternative to the Bakri balloon is the condom balloon tamponade, proposed by Dr. Sayeba Akhter and colleagues in 2003. It is made from a condom, a Foley catheter, string or spare suture, and sterile water or saline. The total cost of the device is less than 5 USD. In GO MOMS simulations, residents practice making and inserting condom tamponade balloons in neoprene vaginal models.

Materials

Bakri Balloon:

  • Condom
  • Foley catheter, any size
  • Piece of spare suture or string
  • Sterile water or saline
  • 60cc syringe, or similar
  • Hemostat or small clamp

Uterus

  • Neoprene uterus from B-Lynch simulation if available 
Bakri.jpg

Preparations

  1. Fill the Foley catheter tip balloon bulb with 5-10cc of water.
  2. To secure the condom over the end of the Foley, open the condom and fit the condom over the end of the Foley.
  3. Secure the condom in place by firmly tying with a piece of suture or string. The string must be tied tight enough to stop water from leaking out of the condom, but not so tight that water cannot be pushed up through the Foley. 
  4. Through the urine drainage port, fill the condom with an initial 60cc of water to test for leaking.

    Instructions For using the condom tamponade

    1. Introduce the condom balloon catheter into the uterus
    2. Inflate the condom through the urine drainage port using water or saline
      • 250-500cc water as needed to fill uterine cavity and bleeding stops
      • Assess with bimanual exam
      • Use the hemostat to clamp off the catheter between fillings
    3. Document the amount of fluid used in order to later confirm complete drainage before removing. Remove the balloon tamponade in maximum 24 - 48 hours (can remove before 24 hours if the patient is stable)
    4. Keep hand in vagina to make sure the balloon tamponade stays inside the uterus
    5. Then pack the vagina with moistened vaginal packing or gauze to keep the balloon tamponade in place. Be sure to count the number of gauze to assure complete removal later 
    6. Mark the top of the fundus and check frequently to assure the mark is not rising as an indication that blood is collecting in the uterus

    Balloon tamponade is primarily used for bleeding post-vaginal delivery, but it can also can be used for post-operative delivery. Place the balloon into the uterine cavity prior to closing the uterine incision and guide the other end of the catheter through the cervical opening into the vagina and out. Close the uterine incision in the usual fashion but be extremely careful not to incorporate the condom as it is non-absorbable. Inflate the balloon and check for vaginal bleeding.

    References:

    1. Use of a condom to control massive postpartum hemorrhage, Akhter et al, Medscape, 2003, PDF Here
    2. Use of condom tamponade to manage obstetric hemorrhage at a tertiary centre in Rajasthan, Hasabe et al, OGI, 2015, PDF Here