Problem
Caesarian hysterectomy is a lifesaving surgery for severe peri-partum
hemorrhage. 1-3 Post hysterectomy pelvic hemorrhage is
a problematic event -with very limited treatment options- that may occur
despite secure ligation of all accessible vascular pedicles. Such
resistant, potentially fatal, bleeding is contributed to by complex
factors including excessive tissue trauma, coagulopathy, and infection.
Pelvic packing is a well-recognized intervention, that utilizes
mechanical compression on blood vessels until physiologic hemostasis is
achieved 4,8,9. Its effectiveness is reported to be
between 78-100% 5-7, particularly in controlling
bleeding from oozing surfaces 8-9. Lap sponge-based
packing requires a second laparotomy with an increased risk of febrile
morbidity. Pelvic pneumatic balloon tamponade does not require second
laparotomy and enables instantaneous monitoring and modification of
applied pressure through inflation-deflation. Reported pelvic balloon
tamponades include Foley catheter, Bakri balloon, and condom10-11. They appear to provide satisfactory outcomes,
nevertheless, the inflation capacity of Foley catheter and low tensile
strength of condoms may present limitations. Bakri balloon is of
high-cost not affordable in low-resourced settings.