Abstract:
Background: Postpartum hemorrhage (PPH) remains a main cause of maternal
mortality in the world, specially in low-resource settings. Uterine atony, the
most common cause of PPH, often requires rapid and effective management to
prevent life-threatening complications. While intramuscular (IM) oxytocin is
the first-line intervention, cases unresponsive to uterotonics necessitate
additional measures. Uterine balloon tamponade (UBT) has emerged as a
minimally invasive and cost-effective technique for managing atonic PPH. This
study evaluates the safety and efficacy of prophylactic use of Dr. Burke’s Every
Second Matters-Uterine Balloon Tamponade (ESM-UBT) combined with IM
oxytocin versus IM oxytocin alone in preventing atonic PPH among women at
high risk.
Methods: This randomized parallel-group trial was conducted over 1.5 years at
Shri B.M. Patil Medical College, Hospital, and Research Centre, Vijayapura. A
total of 226 women with high-risk pregnancies for atonic PPH were enrolled
and randomized into two groups: Group 1 received prophylactic ESM-UBT
with IM oxytocin (10 units), while Group 2 received only IM oxytocin. Blood
loss was measured using the BRASS V drape and additional gauze pad weight
assessment. Hemoglobin levels were recorded pre-delivery and 48 hours
postpartum. Analysis was performed using a software SPSS version 20.
Results: The prophylactic use of ESM-UBT significantly reduced total blood
loss (median: 120 mL vs. 320 mL, p < 0.01) and post-delivery hemoglobin drop
(Group 1: 9.9 g/dL vs. Group 2: 9.2 g/dL, p = 0.0049). Blood loss at 5, 10, and
60 minutes postpartum was consistently lower in the ESM-UBT group (p <
0.0001). The requirement for additional uterotonics and blood transfusion was
significantly higher in the IM oxytocin-only group (p = 0.002, p = 0.013,
respectively).
Conclusion: Prophylactic ESM-UBT significantly reduces blood loss and the
need for additional interventions in high-risk women, demonstrating its
potential as a vital tool in PPH prevention, particularly in resource-limited
settings. Its cost-effectiveness and ease of use make it a feasible solution for
improving maternal outcomes globally.
