Low Cost Condom Tamponade Technique Saves Lives

Khotang, Nepal

Parbati Acharya, an auxiliary nurse midwife (ANM) at Durchhim Health Post, had a difficult case on her hands. She was already done with her shift, but as the only skilled birth attendant at this remote health facility, she was used to working long hours.

“She appeared to be out of her senses,” Parbati recalls. “That’s when I realized it was postpartum hemorrhage, and I had no time to spare.”

Her patient was a young woman who had been struggling to give birth for more than 13 hours now. Muna Rai, 20, had gone into labor at 4:30 PM the previous day. At 5 AM the next morning, the contractions were still not strong enough for active labor. Parbati had tried everything - helping the young woman walk around, feeding her warm liquids, taking her to the bathroom whenever she needed to go - and with the passing minutes, she was becoming anxious. She asked the ambulance driver to be prepared in case Muna had to be referred to Dhulikhel Hospital. It would be a rough six-hour drive through the hills to reach the referral hospital, if it came to that.

An hour later, Muna finally went into active labor. It would be another seven hours before the baby was delivered, but both mother and newborn appeared to be safe. Parbati transferred Muna to the postnatal ward, and took a break to have lunch. Almost immediately, a man came rushing to her, clearly distressed.

“My wife is in pain,” he said, in a quivering voice. “She is badly bleeding!”

Parbati dashed back to the health post. Her heart sank at the scene before her.

Muna was lying in a pool of blood, with a blood clot almost the size of a basketball next to her, on sheets that had turned dark red.

Parbati with her patient Muna

Parbati with her patient Muna

“She appeared to be out of her senses,” Parbati recalls. “That’s when I realized it was postpartum hemorrhage (PPH), and I had no time to spare.”

One question rang loud inside Parbati’s head - how come this mother had PPH? She did have a prolonged labor, but the delivery was normal.

Suspecting that a strand of placenta or a membrane had been retained in the uterus, Parbati called out to another on-duty ANM for help. Their immediate and obvious task was to stabilize the vital signs of the mother. After setting Muna up with a Methergine drip in one hand, and Oxytocin in the other, Parbati began examining her uterus. She could not find any cervical or perineum tears, but the bleeding continued.

Then, Muna’s blood pressure rapidly declined, and she started to mumble unconsciously. A chill went down Parbati’s spine.

“I felt helpless,” she says. “Her uterus was clean. She had a very normal delivery. But she was dispelling blood clots and occasionally turning blue.”

Not finding any clues, Parbati thought hard about what she could do to save this young mother. That’s when it struck her - like a last-minute revelation - to employ the condom tamponade technique.

Assembly of a condom tamponade

Assembly of a condom tamponade

Two weeks before, Parbati attended a One Heart World-Wide (OHW) training for health professionals working in the remote corners of Nepal. It was a three-day refresher course on pregnancy complications which had an extensive session on the condom tamponade procedure and how it could be used to save lives.

First developed in Bangladesh in 2001, the low cost technique is a kind of intrauterine balloon, created from a catheter, a male latex condom, and a string to tie the condom to the catheter. Once inside the uterus, it is inflated, and the pressure against the uterine walls works to alleviate and stop refractory bleeding. A relatively simple procedure with low surgical morbidity, it has been proven effective in 80 percent of cases. In 2013, OHW became the first organization to introduce condom tamponade to Nepal, after getting government approval to bring in the equipment and conduct trainings on the procedure.

“It makes me very emotional when I meet these mothers I have saved, and see how they are doing now,” says Parbati. “Sometimes they come to visit me with gifts. I treasure them like they are my awards.”

Parbati gave her colleague instructions to prepare the equipment while she checked Muna’s vital signs again. Two hours after employing condom tamponade, Muna was no longer bleeding, and her vital signs returned to normal. Parbati breathed a sigh of relief.

At around 1 AM that night, the young mother called out for something to eat. Parbati made her a bowl of hot vegetable soup, and watched her eat. Soon she fell into a sound sleep, and an hour later, Parbati left for her own sleeping quarters. Muna was kept under supervision for a week at the maternity waiting home before she was discharged.

Though Parbati is just doing her job when she helps women like Muna through their pregnancy and delivery, the bond that is created between them goes much deeper.

“It makes me very emotional when I meet these mothers I have saved, and see how they are doing now,” says Parbati. “Sometimes they come to visit me with gifts. I treasure them like they are my awards.”