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.