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The “tamponade test” in the management of massive postpartum hemorrhage
LETTERS TO THE EDITOR
The “Tamponade Test” in the Management of Massive Postpartum Hemorrhage
nostic: the “SOS Tamponade Balloon,”2 designed for management of cases of obstetric and gynecologic pelvic hemorrhage and seemingly simpler and less expensive and, perhaps, more effective than the Sengstaken–Blakemore balloon.
To the Editor:
Nikita Aggarwal, MD 100 West Carson Street Torrance, CA 90502
Condous et al1 are to be congratulated for establishing a method that eliminates the “guess” factor from the management of postpartum hemorrhage. The “tamponade test” is a direct and correct monitor to guide and plan treatment. However, we prefer to use the recently introduced tamponade obstetric hemorrhage balloon2 (COOK Ob/Gyn, Limerick, Ireland), which achieves the same results at less cost. Additional advantages are the larger balloon volume and wider drainage shaft. Singeetaa M. Sinha 143 Cedar Street Birmingham, MI 48009 REFERENCES 1. Condous GS, Arulkumaran S, Symonds I, Chapman R, Sinha A, Razvi K. The “tamponade test” in the management of massive postpartum hemorrhage. Obstet Gynecol 2003; 101:767–72. 2. Bakri Y, Amri A, Abdul Jabbar F. Tamponade balloon for obstetrical bleeding. Int J Gynaecol Obstet 2001;74: 139–42.
To the Editor: I commend Condous et al1 for their well-written and informative article highlighting the importance of objective assessment of postpartum hemorrhage by measuring the exact “volume” of blood loss rather than the traditional and subjective “estimated” blood loss, which is frequently inaccurate. The tamponade test solves the problems and shortcomings of packing techniques that serve the tamponade advantage but “mask” active bleeding. My only critique is that Condous et al did not elaborate upon a newer and more cost-effective tamponade drainage balloon system that achieves the same objectives as the tamponade test, both therapeutic and diag-
REFERENCES 1. Condous GS, Arulkumaran S, Symonds I, Chapman R, Sinha A, Razvi K. The “tamponade test” in the management of massive postpartum hemorrhage. Obstet Gynecol 2003; 101:767–72. 2. Bakri Y, Amri A, Abdul Jabbar F. Tamponade balloon for obstetrical bleeding. Int J Gynaecol Obstet 2001;74: 139–42.
In Reply: The principle of the tamponade test is to have a balloon that will distend in the uterine cavity and occupy the entire space and also create intrauterine pressure that is greater than the systemic arterial pressure. The blood flow into the uterus should stop the moment the pressure in the tamponade balloon is greater than that of the systemic arterial pressure. The balloon should also distend in such a manner that it occupies the entire uterine space in the postpartum period. To achieve this there are a number of balloons used, including urological balloons and others specially designed for this purpose, such as the SOS Tamponade Balloon.1 In Bakri and colleagues’ series of five cases, two involved bilateral hypogastric artery ligation. The purpose of our article was to collect a large series of cases where balloon was the only method used. The principle is that of using the tamponade as a prognostic index to see whether laparotomy is needed and also as a therapeutic measure if the bleeding stops. S. Arulkumaran, PhD, FRCOG G. Condous, MRCOG St. George’s Medical School Cranmer Terrace London SW17 0RE, United Kingdom
VOL. 102, NO. 3, SEPTEMBER 2003 © 2003 by The American College of Obstetricians and Gynecologists. Published by Elsevier.
0029-7844/03/$30.00 doi:10.1016/S0029-7844(03)00581-7
641
The “Tamponade Test” in the Management of Massive Postpartum Hemorrhage
nostic: the “SOS Tamponade Balloon,”2 designed for management of cases of obstetric and gynecologic pelvic hemorrhage and seemingly simpler and less expensive and, perhaps, more effective than the Sengstaken–Blakemore balloon.
To the Editor:
Nikita Aggarwal, MD 100 West Carson Street Torrance, CA 90502
Condous et al1 are to be congratulated for establishing a method that eliminates the “guess” factor from the management of postpartum hemorrhage. The “tamponade test” is a direct and correct monitor to guide and plan treatment. However, we prefer to use the recently introduced tamponade obstetric hemorrhage balloon2 (COOK Ob/Gyn, Limerick, Ireland), which achieves the same results at less cost. Additional advantages are the larger balloon volume and wider drainage shaft. Singeetaa M. Sinha 143 Cedar Street Birmingham, MI 48009 REFERENCES 1. Condous GS, Arulkumaran S, Symonds I, Chapman R, Sinha A, Razvi K. The “tamponade test” in the management of massive postpartum hemorrhage. Obstet Gynecol 2003; 101:767–72. 2. Bakri Y, Amri A, Abdul Jabbar F. Tamponade balloon for obstetrical bleeding. Int J Gynaecol Obstet 2001;74: 139–42.
To the Editor: I commend Condous et al1 for their well-written and informative article highlighting the importance of objective assessment of postpartum hemorrhage by measuring the exact “volume” of blood loss rather than the traditional and subjective “estimated” blood loss, which is frequently inaccurate. The tamponade test solves the problems and shortcomings of packing techniques that serve the tamponade advantage but “mask” active bleeding. My only critique is that Condous et al did not elaborate upon a newer and more cost-effective tamponade drainage balloon system that achieves the same objectives as the tamponade test, both therapeutic and diag-
REFERENCES 1. Condous GS, Arulkumaran S, Symonds I, Chapman R, Sinha A, Razvi K. The “tamponade test” in the management of massive postpartum hemorrhage. Obstet Gynecol 2003; 101:767–72. 2. Bakri Y, Amri A, Abdul Jabbar F. Tamponade balloon for obstetrical bleeding. Int J Gynaecol Obstet 2001;74: 139–42.
In Reply: The principle of the tamponade test is to have a balloon that will distend in the uterine cavity and occupy the entire space and also create intrauterine pressure that is greater than the systemic arterial pressure. The blood flow into the uterus should stop the moment the pressure in the tamponade balloon is greater than that of the systemic arterial pressure. The balloon should also distend in such a manner that it occupies the entire uterine space in the postpartum period. To achieve this there are a number of balloons used, including urological balloons and others specially designed for this purpose, such as the SOS Tamponade Balloon.1 In Bakri and colleagues’ series of five cases, two involved bilateral hypogastric artery ligation. The purpose of our article was to collect a large series of cases where balloon was the only method used. The principle is that of using the tamponade as a prognostic index to see whether laparotomy is needed and also as a therapeutic measure if the bleeding stops. S. Arulkumaran, PhD, FRCOG G. Condous, MRCOG St. George’s Medical School Cranmer Terrace London SW17 0RE, United Kingdom
VOL. 102, NO. 3, SEPTEMBER 2003 © 2003 by The American College of Obstetricians and Gynecologists. Published by Elsevier.
0029-7844/03/$30.00 doi:10.1016/S0029-7844(03)00581-7
641