Managing postpartum haemorrhage with free-flow pressure-controlled uterine balloons

Background/aims Uterine balloon tamponade is an accepted management method for refractory postpartum haemorrhage. A previous case series was conducted in Cape Town, South Africa with a uterine balloon tamponade used by doctors, where the success rate was 78.9%. The next step was the roll out of the skill to midwives in midwife obstetric units, which was investigated in this study.Methods A case series was conducted in six midwife obstetric units in Metro-East, Cape Town. Hands-on training workshops and one-to-one training sessions were conducted, that aimed at 80% coverage. Following this training, the devices were made available to midwife obstetric units at no cost, along with instructions for their use. Structured interviews were conducted with midwives that used the device during the study period. The interview included questions about correct placement of the uterine balloon, ease of placement and effect on uterine bleeding.Results Training saturation ranged between 92% and 100%. A total of 12 cases with 10 attempted placements were reported, of which eight were performed by midwives. In all eight cases, the bleeding stopped quickly following inflation of the uterine balloon. Use of the uterine balloon tamponade for postpartum haemorrhage treatment was received with enthusiasm by midwives and the skill was easy to acquire. The additional management option for postpartum haemorrhage was welcomed.Conclusions The skill of using a uterine balloon tamponade was easily acquired by the midwives. This device should be included in the postpartum haemorrhage management bundle, as it will reduce blood loss in refractory cases, resulting in safer transfers.