Postpartum Hemorrhage (PPH) is bleeding greater than 500 ml occurring in the first 24 hours after delivery. This bleeding can become severe and life threatening, causing about 100,000 deaths per year. The great majority of these deaths occur in low-resource settings, where diagnosis and treatment are more difficult while the women also more often have complicating factors like anemia.
Mechanism of Action:
After the use of uterotonics and before the removal of the mother's uterus by hysterectomy, further interventions may be necessary to stop the bleeding. A second treatment method, balloon tamponade, applies direct pressure to the uterus which slows and stops blood flow. It does this both by decreasing the total blood flow through pressure and by allowing the blood conditions suitable for clot formation.
Current use in High-Resource Settings:
Uterotonics, direct pressure, and hysterectomy are more common in high-resource settings. The balloon tamponade has some use in uncontrolled traumatic uterine bleeding, and is being used more frequently for uterine atony.
Current use in Low-Resource Settings:
Practice in low-resource contexts varies from uterine massage and uterotonics to hysterectomy or other surgery. All these procedures can contribute to slowing PPH. Balloon tamponade is not common at many hospitals, but has been suggested for use in low-resource settings as it can be used by relatively low skilled health providers and successfully stops many cases of postpartum hemorrhage. The device used varies from the relatively high cost Bakri or Blakemore balloons to less expensive options and even the combination of a catheter, condom, and bag of saline.