October 2022 · Volume 11 · Issue 10 Page 2924 International Journal of Reproduction, Contraception, Obstetrics and Gynecology Shetty SS et al. Int J Reprod Contracept Obstet Gynecol. 2022 Oct;11(10):2924-2942 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 Review Article A narrative review comparing clinical effectiveness of commonly used uterine balloon tamponade devices for postpartum haemorrhage management in India Siddesh S. Shetty 1 , Kusum V. Moray 1 , Oshima Sachin 2 , Himanshu Chaurasia 3 , Beena Joshi 4 * INTRODUCTION Haemorrhage is the foremost direct cause of maternal mortality globally. Around two-third of maternal deaths due to bleeding worldwide is due to postpartum haemorrhage (PPH). 1 PPH is defined as maternal blood loss of 500 ml or more within 24 hours after childbirth affecting nearly 5% of all women. 2 The commonest aetiology for PPH is atony of the uterus. 3 Uterotonics along with fluid resuscitation and uterine massage is the recommended choice for PPH treatment. 4 WHO endorses using intrauterine balloon tamponade (UBT) for refractory atonic PPH cases that are unresponsive to uterotonics after vaginal delivery. 5 If medical and conservative measures fail, surgical interventions are considered. 4 UBT is a relatively simple lifesaving technique that can reduce the requirement for surgery and aid as a temporizing measure during patient referral. UBT technique involves insertion of a balloon device into the uterus, incrementally filling it with liquid to increase pressure above systemic arterial pressure to prevent further blood loss and aid uterus contraction. 6 The Indian guidelines recommend using UBT in refractory atonic PPH cases. 7,8 Specifically designed or improvised UBT devices are available. Bakri balloon, condom catheter/modifications, Sengstaken- Blakemore oesophageal tube, Every second matters DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20222509 1 Ex- HTA Resource Hub, ICMR National Institute for Research in Reproductive and Child Health, India 2 HTA, Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India 3 HTA Resource Hub, ICMR National Institute for Research in Reproductive and Child Health, India 4 Indian Council of Medical Research, National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai, Maharashtra, India Received: 23 August 2022 Revised: 15 September 2022 Accepted: 16 September 2022 *Correspondence: Dr. Beena Joshi, E-mail: bjoshithane@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT WHO recommends using uterine balloon tamponade (UBT) for refractory atonic postpartum haemorrhage (PPH) management provided treatment protocols and surgical recourse is possible. This review collated literature from three electronic databases between January 2010 to December 2019 to compare clinical effectiveness, safety and use related parameters for condom-UBT, Bakri balloon and every second matters (ESM) UBT devices used in India. Thirty-three eligible studies reported effectiveness in managing all PPH causes ranging from 84.2% to 98.3% for condom- UBT and from 65.3% to 94.8% for Bakri-UBT. Three ESM-UBT studies reported PPH survival rates of 94% to 97.4%. Mean UBT effectiveness in controlling atonic PPH was 92.3% for condom-UBT, 84.3% for Bakri-UBT and 97.3% for ESM- UBT. Condom-UBT and Bakri-UBT were comparable across parameters whereas limited ESM-UBT evidence reported success in preventing maternal deaths. For limitations and heterogeneity in methodology and outcome parameters with existing evidence, a robust comparative RCT between UBT devices in India is recommended. Keywords: Clinical effectiveness, Bakri balloon UBT, Condom-UBT, ESM-UBT, Post-partum haemorrhage