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5A

Skills: Inserting and using intra-uterine balloon tamponade to treat postpartum haemorrhage

Contents

Objectives

When you have completed this skills chapter you should be able to:

Unique features of the Ellavi intra-uterine balloon

The Ellavi intrauterine balloon is an open system that:

Note
The Ellavi intrauterine balloon is based on the same principles as the surgical glove balloon described in the 2010 NCCEMD Monograph of the management of postpartum haemorrhage.

Prerequisites for use

In the labour ward following:

In theatre:

Note
The Ellavi intrauterine balloon could be used to temporise blood loss prior to taking the patient to theatre for an evacuation.

Preparation prior to use

Use aseptic technique to:

Insertion into the uterus

Sterile gloves must be used for inserting the balloon into uterus:

If a drip stand is available:

If a drip stand is not available:

Tape the tube distal to the T-valve to the patient’s upper leg with some leeway for movement.

Antibiotic prophylaxis

Prescribe a 5 day course of broad spectrum antibiotics using intravenous ampicillin and oral metronidazole or intravenous cefuroxime. The intravenous ampicillin and cefuroxime should be replaced by oral equivalents after 24 hours if the patient’s condition is stable.

Transfer

When the patient is transferred, close the T-valve for the duration of the journey.

Intra-uterine pressure control

Determine the blood pressure:

Systolic blood pressure Height of bag above patient
80 mm Hg 1.1 m
100 mm Hg 1.3 m
120 mm Hg 1.6 m
140 mm Hg 1.8 m
160 mm Hg 2.1 m

Monitoring for bleeding

Closely observe the patient for bleeding and signs of shock. The blood pressure and pulse need to be measured every 15 minutes and continuously check the amount of vaginal bleeding.

Removal

After 8 hours of insertion, check the blood pressure and pulse rate as well as general condition of the patient for clinical signs of shock:

Cautions and warnings