An Inflatable Surgical Glove to Control Postpartum Bleeding to Prevent Caesarean Hysterectomy

Abstract

Background: Postpartum hemorrhage (PPH) is one of the most critical causes of maternal morbidity and mortality, particularly in low-resource settings. Timely and effective interventions are necessary to prevent invasive procedures such as caesarean hysterectomy, which may have profound effects on maternal health, fertility, and psychosocial well-being. Glove uterine tamponade (GUT) is a low-cost, conservative technique used to manage refractory PPH. However, its success is variable and may depend on a range of maternal, obstetric, and procedural factors. Objective: To identify the predictors of success or failure of glove uterine tamponade (GUT) in the management of postpartum hemorrhage, with a specific focus on maternal, obstetric, and procedural characteristics. Methodology: This Descriptive cross-sectional study was conducted at the department of Obstetrics & Gynecology, Peoples University of Medical and Health Sciences (PUMHS), Nawabshah, from June 08, 2023 to December 07, 2023. Sampling Technique: Non-probability consecutive sampling. Inclusion Criteria: Women with primary PPH due to uterine atony, placenta previa, or accreta unresponsive to medical therapy. Exclusion Criteria: PPH due to genital tract trauma or retained placental tissue. Data Collection: Structured proforma and interviews were used to record demographic, obstetric, and procedural data, including age, BMI, parity, delivery mode, PPH cause, time to GUT insertion, saline volume used, transfusion details, and outcome. Data Analysis: Data was analyzed using SPSS v25. Results: Of the 34 women treated with GUT, success was observed in 17 cases (50%) and failure in 17 cases (50%). GUT success was more common in women with placenta previa (63.6%) and uterine atony (53.8%), while failure was highest in placenta accreta (70%). Cesarean deliveries, previous cesarean history, and higher transfusion requirements were more frequent in failure cases. The average time to GUT insertion and volume of saline used were slightly higher in successful cases. Transfusion reactions and the need for adjunct therapies were more common in failed interventions. Conclusion: The effectiveness of GUT is significantly influenced by the cause of PPH, prior obstetric history, and intra-procedural factors such as volume used and adjunctive treatments. Early identification of high-risk cases and appropriate selection of candidates for GUT could reduce the need for surgical interventions. These findings support the need for further studies and integration of predictive factors into obstetric training and policy guidelines to promote safe and conservative PPH management.