The effect of prophylactic oral tranexamic acid plus buccal misoprostol on blood loss after vaginal delivery: a randomized controlled trial

Objective: The objective of this study is to evaluate the effect of prophylactic oral tranexamic acid (TA) plus buccal misoprostol on the amount of blood loss after vaginal delivery in women at low risk for post-partum hemorrhage (PPH).

Materials and methods: The study was a randomized open label clinical trial conducted in a tertiary University Hospital between January 2016 and June 2017. We included women who delivered vaginally with a singleton pregnancy. They were randomized into three groups: group I (women received 10?IU oxytocin IV after delivery of the baby), group II (women received 600?µg buccal misoprostol after delivery of the baby), and group III (women received 1000?mg oral TA at the end of the first stage of labor plus 600 µg buccal misoprostol after delivery of the baby). In each group, pre- and post-delivery pulse rate, blood pressure, temperature, and hemoglobin level were evaluated. Additionally, the amount of blood loss, need for blood transfusion, need for additional uterotonics, and side effects of the study medications were recorded.

Results: There was a statistically significant lower hemoglobin level and higher blood loss in the misoprostol group compared with oxytocin group and TA plus misoprostol group (p?=?.0001). There was a statistically significant higher hemoglobin level and lower blood loss in the TA plus misoprostol group compared with the oxytocin group (p?=?.004 and .043, respectively). PPH occurred in 16.7% of women in the misoprostol group compared 1.7% in the oxytocin group and no cases of PPH in the TA plus misoprostol group (p?=?.0001).

Conclusions: In settings like rural area or home delivery in which oxytocin is not available, alternative oral TA plus buccal misoprostol may be considered as an effective line in prevention of PPH.     

Manual removal versus spontaneous delivery of the placenta at cesarean section in developing countries: a randomized controlled trial and review of literature

Purpose: Cesarean section (CS) rates have increased; this is especially concerning in developing countries. The mode of placental delivery contributes to morbidity associated with CS and determines blood loss during CS. We aimed to compare manual removal versus spontaneous delivery of the placenta at CS.

Methods: In a randomized controlled trial, 574 women admitted for primary or repeat elective CS were randomized into two groups. In group A, the placenta was manually removed, whereas in group B, the placenta was left for spontaneous delivery. Blood loss, operative and postoperative data were recorded.

Results: Blood loss was 875.2?±?524.2?ml in group A versus 731.8?±?426.7?ml in group B (p?=?.001), with a significant drop in postoperative HB (p?=?.015) and HCT (p?=?.031). In group A, odds ratios for blood loss (>1000?ml), HB drop (>?4g/dl), postpartum hemorrhage and blood transfusion were 2.581, 2.850, 2.614 and 1.665, respectively. However, the total operative time (p?=?.326), duration of hospital stay (p?=?.916) and intensive care unit (ICU) admission (p?=?.453) were not statistically different between the two groups.

Conclusions: Manual removal of the placenta at CS is associated with a higher risk of blood loss, postpartum hemorrhage and blood transfusion, with no decrease in operative time.     

Carbetocin versus oxytocin to reduce additional uterotonic use at non-elective caesarean section: a double-blind,randomised trial*

Objective: We compared the efficacy of Carbetocin (long-acting oxytocin receptor agonist) versus Oxytocin given at non-elective caesarean section.

Method: We performed a double-blind, randomised, single-centre study. Eligible women were?≥37 weeks of gestation undergoing emergency caesarean section. Participants received either carbetocin of 100?μg or oxytocin 5 international units. The primary outcome was the need to administer additional uterotonics, as determined by the clinician. Secondary outcomes included estimated blood loss, haemoglobin drop pre–post operation and the need for a blood transfusion

Results: From August 2012 to February 2013, 114 women were enroled. Two were excluded from analysis as they received a general anaesthetic. Fifty-nine patients received 100-μg carbetocin; 53 received 5 international units oxytocin. There was no statistically significant difference in the number of women requiring additional uterotonics between the two groups: Carbetocin group 22% and Oxytocin group 13% (p?=?0.323). There were no significant differences in the fall in haemoglobin, estimated blood loss, rates of post-partum haemorrhage or blood transfusions.

Conclusion: Oxytocin and carbetocin have similar requirements for additional uterotonics, estimated blood loss, haemoglobin drop and blood transfusions. There was a trend towards requiring additional uterotonics in patients receiving Carbetocin which was not statistically significant. This study found no benefits in using carbetocin over oxytocin.     

Early versus delayed amniotomy during labor induction with oxytocin in women with Bishop’s score of ≥6: a randomized trial

Objective: To study the effect of “early amniotomy” {initiating induction of labor (IOL) with amniotomy followed by oxytocin} versus “late amniotomy” (initiating IOL with oxytocin followed by amniotomy 4–8?h later) in induced labor.

Methods and Materials: One hundred and fifty women with Bishop’s score of ≥6 undergoing IOL were randomized into “early amniotomy” and “delayed amniotomy”.

Results: Early amniotomy resulted in a reduced induction-delivery interval (IDI) (7.35 versus 11.66?h with delayed amniotomy, p?=?.000) but higher the caesarean section (CS) rate was observed (10.7 versus 2.7% with delayed amniotomy, p?=?.049). With early amniotomy, the proportion of women delivering within 12?h was higher (86.7 versus 60%, p?=?.000) and the maximum oxytocin concentration used was lower (30.05 versus 39.68?mU/min, p?=?.001) as compared to delayed amniotomy. The neonatal outcomes were similar in the two groups. Early amniotomy detected meconium prior to initiating uterine contractions with oxytocin in three women who underwent CS for meconium.

Conclusion: Initiating IOL with amniotomy in women with a favorable cervix was efficacious in expediting delivery, but it resulted in a higher CS rate. The higher CS rate was partly due to CS for meconium detected as a result of early amniotomy.

Clinical Trials Registry (CTRI), India: Registration number CTRI/2015/01/005418     

Different routes and forms of uterotonics for treatment of retained placenta: a randomized clinical trial*

Objectives: To compare between three different uterotonics (oxytocin, carbetocin and misoprostol) given via three different routes (intraumbilical, intravenous and sublingual, respectively) in reducing the need for manual removal of placenta (MROP).

Methods: A randomized trial for cases with retained placenta 30?min following vaginal delivery. They received intraumbilical oxytocin, intravenous carbetocin or sublingual misoprostol. Main outcome measures were delivery of the placenta within 30?min following drug administration, and need for MROP. Secondary outcome measures were injection to placental delivery time, post-delivery hemoglobin, need for blood transfusion or additional uterotonics.

Results: The overall success rate was 66.7% (64/96), 71.3% (67/94) and 63.7% (58/91) for oxytocin, carbetocin and misoprostol groups, respectively (p?>?0.05). When time needed to achieve placental delivery considered, a significant difference was observed with the shortest time for carbetocin (16.61?±?3.76?min), then oxytocin (18.28?±?3.34?min) and lastly misoprostol (23.00?±?3.38?min) (p?<0.001). Again, carbetocin group needed less additional uterotonics to achieve adequate uterine contractions (p?<0.001).

Conclusions: Although we aimed to exploit the advantage of certain drug over another, all seemed to have close efficacy but it would be important that further research should highlight availability, cost, ease of administration and storage requirements to determine which agent would best be used in this clinical scenario.     

A sandwich technique (N&H variation technique) to reduce blood loss during cesarean delivery for complete placenta previa: a randomized controlled trial

Objective: To investigate the effect of A sandwich technique Nahla &; Hany variation (N&;H) technique versus stepwise uterine devascularization on blood loss during cesarean section (CS) in patients with complete placenta previa.

Methods: The study was single-blind randomized controlled trial carried out in a tertiary University Hospital between March 2015 to March 2018. We included patients scheduled for CS due to complete placenta previa. They were randomly allocated to group (I) managed by stepwise uterine devascularization, group (II) managed by double transverse compression suture at the lower uterine segment plus intrauterine inflated Foley’s catheter Balloon (H&;N variation sandwich) at the lower uterine segment. The primary outcome was the amount of total estimated blood loss both intra- and post-operative.

Results: One hundred and six patients were enrolled (n?=?53 in each group). There was a great reduction in intraoperative blood loss in group II 570 (400–1300) compared with Group I 1030 (500–1540) (p?=?.0001), or blood in the intraabdominal drain in group II than group I (p?=?.0001) Also, there was no significant reduction in postoperative vaginal bleeding. Hence, the total estimated blood loss in group II 750 (550–1580) showed significant reduction compared with group I 1350 (780–1800) (p?=?.0001).

Conclusions: N&;H variation sandwich technique in the management of complete placenta previa is a simple technique, safe and effective to decrease blood loss.     

Carbetocin versus syntometrine for prevention of postpartum hemorrhage after cesarean section

Objective: To compare effectiveness and tolerability of carbetocin versus syntometrine in prevention of postpartum hemorrhage (PPH) after cesarean section (CS).

Methods: A double-blind randomized study conducted on 300 pregnant subjected randomly either to single 100?μg IV dose of carbetocin (150 women) or combination of 5?IU oxytocin and 0.2?mg ergometrine (150 women) after fetal extraction and before placental removal. Primary outcome parameter was the occurrence of PPH. Other parameters were hemoglobin and hematocrit changes, the need of additional oxytocic, hemodynamic changes and occurrence of side effects.

Results: There was no significant difference between the two study groups regarding hemoglobin and hematocrit at start of CS and after 2 days of surgery and mean blood loss during the operation (p?>?0.05). There was a highly significant difference between the two study groups regarding incidence of primary PPH (2.7% versus10%) and the need of additional oxytocic (3.3% versus17.3%). Women in oxytocin group showed a statistically significant lower systolic and diastolic blood pressure at 1, 5 and 30?min than women in carbetocin group. Women in carbetocin group experienced more metallic taste, flushing, headache, dizziness, dyspnea and itching, while women in oxytocin methergine group experienced more palpitations.

Conclusions: Carbetocin is a reasonable effective alternative to syntometrine in prevention of PPH after cesarean delivery.     

Efficacy of tranexamic acid in decreasing blood loss in elective caesarean delivery

Objective: To evaluate the efficacy of tranexamic acid (TA) in decreasing blood loss during and after elective caesarean section (CS).

Methods: This prospective randomized trial was conducted among 124 pregnant women subjected to term elective CS. Patients were equally divided into two groups. Study group received 10?mg/kg TA intravenously 5?min before skin incision while the control group did not. In addition, both groups received 10 units oxytocin and 1?ml ergometrine after delivery of the fetus. Blood loss in both groups was measured from placental delivery to end of the surgery and from end of the surgery to 2?h postpartum. Hemoglobin and hematocrit values were determined preoperatively and on the third day postpartum (before discharge) for all cases. Maternal and neonatal adverse effects in study groups were recorded.

Results: TA group showed lower amount of blood loss (391?ml) when compared to control group (597?ml). Risk estimation has revealed that treatment with TA resulted in decrease in risk of postpartum blood loss by 30%. Hemoglobin and hematocrit levels were significantly lower in the control group on the third post-operative day.

Conclusion: TA reduces blood loss during and immediately after CS. Its use in caesarean delivery may be considered especially in cases where blood loss is expected to be high or in anemic patients.     

Efficacy of oxytocin versus carbetocin in prevention of postpartum hemorrhage after cesarean section under general anesthesia: a prospective randomized clinical trial

Objective: To compare the use of carbetocin and oxytocin in the prevention of postpartum hemorrhage after cesarean section.

Methods: The present study was a prospective double-blind randomized controlled clinical trial performed in two university-based hospitals in Tehran, Iran. Two hundred and twenty women with the gestational age of more than 37 weeks, who needed cesarean operation, participated in the study. Patients were assigned to receive either a single 100?μg IV dose of carbetocin or a standard 30-international unit IV infusion of oxytocin during 2?h after delivery of placenta. The primary outcome measures were postpartum hemorrhage requiring additional uterotonic drugs, bleeding volume, and the hemoglobin drops.

Results: There were meaningful differences in carbetocin versus oxytocin group regarding the hemoglobin drops (1.01 versus 2.05, p?=?.01), bleeding volume (430.68?CC versus 552.6?CC, p?p?p?Conclusions: It may be concluded that carbetocin is a good alternative modality to conventional uterotonic agents such as oxytocin for the prevention of postpartum hemorrhage after cesarean sections.

Registration ID in IRCT: NCT02079558     

A comparison of the efficacy of carbetocin and oxytocin on hemorrhage-related changes in women with cesarean deliveries for different indications

Objective

To compare the efficacy of carbetocin and oxytocin on hemorrhage-related changes in women with cesarean deliveries (CS) for different indications.

Carbetocin versus oxytocin for prevention of postpartum hemorrhage in obese nulliparous women undergoing emergency cesarean delivery

Objective: To assess and compare the effectiveness and safety of single IV polus dose of carbetocin, versus IV oxytocin infusion in the prevention of PPH in obese nulliparous women undergoing emergency Cesarean Delivery.

Methods: A double-blinded randomized-controlled trial was conducted on 180 pregnant women with BMI >30. Women were randomized to receive either oxytocin or carbetocin during C.S. The primary outcome measure was major primary PPH >1000?ml within 24?h of delivery as per the definition of PPH by the World Health Organization Secondary outcome measures were hemoglobin and hematocrit changes pre- and post-delivery, use of further ecobolics, uterine tone 2 and 12-h postpartum and adverse effects.

Results: A significant difference in the amount of estimated blood loss or the incidence of primary postpartum haemorrhage (>1000?ml) in both groups. Haemoglobin levels before and 24-h postpartum was similar. None from the carbetocin group versus 71.5% in oxytocin group needed additional utrotonics (p?<?0.01). The uterine contractility was better in the carbetocin group at 2, and 12-h postpartum (p?<?0.05).

Conclusions: A single 100-µg IV carbetocin is more effective than IV oxytocin infusion for maintaining adequate uterine tone and preventing postpartum bleeding in obese nulliparous women undergoing emergency cesarean delivery, both has similar safety profile and minor hemodynamic effect.     

Differences in outcomes between cesarean section in the second versus the first stages of labor

Objective: We aimed to compare maternal morbidity and mortality of cesarean sections (CS) in the second versus first stage of labor.

Study design: Retrospective study of all CS at a single, university-affiliated medical center, between January 2010 and December 2014. Eligibility was limited to term, singleton pregnancies with cephalic presentation. Maternal outcomes of second-stage CS were compared to those of first-stage CS. The primary outcome was defined as estimated blood loss >1000?ml.

Results: Overall, 1004 women met the inclusion criteria, of which 290 (29%) had a second-stage CS and 714 (71%) had a first-stage CS. Women in the second-stage CS group had a higher nulliparity and hypertensive disorders rates and a lower rate of previous CS. Second-stage CS was associated with more than double the rate of estimated blood loss >1000?ml (9.7% versus 3.8%, p<.001), and more prone to unintentional uterine incision extension, uterine atony, hemoglobin decrease >2?g/l and antibiotic treatment for suspected endometritis. In a multivariable logistic regression model, second-stage CS was found to be independently associated with unintentional uterine incision extension (OR 6.8, 95% CI 4.1–11.2), uterine atony (OR 3.3, 95% CI 1.4–8.0) and antibiotic treatment for suspected endometritis (OR 2.6, 95% CI 1.4–5.1), but not with excessive blood loss (OR 1.5, 95% CI 0.8–2.8). Additionally, failed assisted vaginal delivery prior to second-stage CS was not associated with a higher rate of complications.

Conclusion: Second-stage CS is associated with higher rates of adverse maternal outcomes, mainly unintentional uterine incision extension, uterine atony, and suspected endometritis.     

Late umbilical cord clamping does not increase rates of jaundice and the need for phototherapy in pregnancies at normal risk

Objective: To verify the relationship between the time of clamping of the umbilical cord and the development of neonatal jaundice, the dosage of bilirubin and the need for phototherapy.

Methods: Cross-sectional, retrospective study with 398 parturients at normal risk (single term gestation, no complications during gestation or delivery, birth weight between 2500 and 4499?g). The population was divided into three groups regarding the time of cord clamping: <1?min(117, 29.4%), between 1 and 3?min(228, 57.3%) and >3?min(53, 13.3%). Sociodemographic, clinical and obstetric characteristics, birth and delivery data, and maternal and perinatal outcomes were evaluated. Pearson’s chi-square test, Fisher’s exact test and the Kruskal–Wallis test were used for comparison between the groups. Statistical significance was considered p?Results: The groups were similar in the development of jaundice (p?=?.370), bilirubin dosage (p?=?.342) and need for phototherapy (p?=?.515). Late clamping was more prevalent in vaginal deliveries when compared to cesarean sections (1–3?min: 64 versus 21.4%, >3?min: 16.6 versus 1%) (p?Conclusion: The clamping time of the umbilical cord showed no association with jaundice, bilirubin dosage, or phototherapy needs in neonates at normal risk. The adoption of late clamping was more prevalent in vaginal deliveries.     

Barbed sutures versus conventional sutures for uterine closure at cesarean section; a randomized controlled trial

Introduction: The aim of this randomized control trial was to compare the operative data and the early postoperative outcomes of cesarean sections in which the uterine incision was closed with a barbed suture (STRATAFIX? Spiral PDO Knotless Tissue Control Device, SXPD2B405, Ethicon Inc.) with those of cesarean sections in which the uterine incision was closed with a conventional smooth suture (VICRYL^?; Ethicon Inc.).

Materials and methods: One hundred pregnant patients were randomized in a 1:1 ratio to the Stratafix group or the Vicryl group. The uterine incision was closed by two layers of sutures in both groups. In the Vicryl group, the first layer was continuous and the second layer was interrupted. In the Stratafix group, both layers were continuous.

Results: The uterine closure time was significantly lower in the Stratafix group (224?±?46 versus 343?±?75?s, p?p value?=?.009). The mean blood loss during closure of uterine incision and mean hospital stay were lower in the Stratafix group but these differences failed to reach statistical significance.

Conclusion: The use of barbed suture for uterine incision closure at cesarean section is associated with shorter uterine closure time and similar early perioperative complications compared with conventional smooth suture. The difference between both groups in the technique of suturing the second layer of the uterine incision may be the cause of the reduction in the uterine closure time and the need for additional sutures to achieve hemostasis during suturing the uterine incision with a barbed suture. Further, well designed randomized controlled trials should be conducted to investigate the association between the type of suture (barbed or conventional smooth) and remote complications of cesarean section (infertility, pelvic pain, abnormal placentation and rupture uterus).     

Timing of antibiotic prophylaxis in cesarean section: retrospective,difference-in-differences estimation of the effect on surgical-site-infection

Background: Cesarean section (CS) is one of the most common surgical procedures performed worldwide. Surgical-site-infection (SSI) occurs in approximately 5–10% of CS. The benefit of prophylactic antibiotics for prevention of SSI has been demonstrated in the literature. The optimal timing of antibiotic prophylaxis (prior to surgical incision versus after cord clamping) was investigated in recent studies. In January 2014, the Israeli Ministry of Health introduced a national quality measure which monitors the administration of prophylactic antibiotics in CS. The custom clinical practice in our medical center was to administer prophylactic antibiotics immediately after cord clamping. Upon introduction of the national quality measurement program, the practice was changed to administration of antibiotics prior to surgical incision. Our objective was to examine the effect of timing of prophylactic antibiotics administration on the incidence of SSI following CS, in a single medical center that performs a large volume of deliveries, with a low rate of CS.

Material and methods: Taking advantage of a discrete change in clinical practice, we used retrospective data and applied difference-in-differences design to estimate the effect of the timing of prophylactic antibiotics administration on SSI rates. The analysis included all CSs performed during 2012–2015 and all hysterectomies conducted during the study period.

Results: The coverage rates of prophylactic antibiotics in CS before and after the policy change were 99.10% and 99.03%, respectively. The rates of SSI following CS, before and after the policy change, were 2.63% (n?=?2499) and 2.32% (n?=?3840), respectively. The rates of SSI following hysterectomy, before and after the policy, change were 6.82% (n?=?396) and 7.09% (n?=?437), respectively. Difference-in-differences (DID) estimates of the effect of policy change on the incidence of SSI in linear and logistic regression models were not significant (B?=??0.6%, p?=?.64; odds ratio?=?0.84, p?=?.58, respectively).

Conclusions: We found no effect of the timing of prophylactic antibiotic administration (prior to surgical incision versus after cord clamping) on SSI rates following CS.     

Use of additional oxytocin to reduce blood loss at elective caesarean section: A randomised control trial

Objective:  The purpose of this prospective, randomised, double-blind, placebo-controlled study was to assess the effects of a 5-IU oxytocin bolus and placebo infusion versus a 5-IU oxytocin bolus and 30 IU infusion on the control of blood loss at elective lower segment caesarean section (C/S).
Methods:  Participants with indication for elective C/S were randomly allocated to two groups. Group A, 360 women, received oxytocin 5 IU bolus and placebo; group B, 360 women received oxytocin 5 IU bolus and 30 IU infusion. Blood loss was estimated based on the haematocrit values before and 48 h after delivery. The primary outcome was the incidence of excessive bleeding (estimated blood loss of >1000 mL), while secondary outcomes included use of additional uterotonics, estimated blood loss, need for blood transfusion, duration of hospital stay and the incidence of adverse effects.
Results:  No demographic difference was observed between groups. Mean estimated blood loss ( P  < 0.001) and the proportion of women with blood loss estimated to be greater than 1000 mL were significantly less for group B than for group A (relative risk (RR) 0.35, 95% confidence interval (CI) 0.20–0.63). In addition, more women in the group A required additional uterotonic agents (RR 0.35, 95% CI 0.22–0.56) and blood transfusion (RR 0.12, 95% CI 0.01–0.98).
Conclusion:  An additional oxytocin infusion after 5 IU oxytocin bolus infusion at elective C/S may reduce blood loss and required blood transfusion.     

Segmental resection of anterior uterine wall in cases with placenta percreta: a modified technique for fertility preserving approach

Aim: The aim of this study was to introduce a modified form of fertility preserving approach in cases with placenta percreta.

Methods: Eleven pregnant women with anterior placenta previa and suspected to have placenta percreta underwent cesarean section between 2015 and 2016 in Zeynep Kamil Women and Children’s Health Training and Research Hospital. In all cases, following confirmation of placenta percreta diagnosis, a modified minimal invasive form of uterine preserving surgery was performed.

Results: During the present study period, 11 pregnant women who were confirmed to have placenta previa and placenta percreta underwent modified form of segmental resection. In all cases, modified form of segmental resection was successful except for the two cases. There were significant statistical differences between pre–postoperative hemoglobin and hematocrit levels (p?=?.003). There was a significant correlation between the volume of resected segment and number of transfusions (r?=?.760, p?=?.047). Postoperative blood transfusion was not needed in 4 cases. No maternal mortality or other postoperative complication was observed in any case.

Conclusion: A modified minimal invasive form of uterine preserving surgery seems to be safe and result in more cosmetic results with minimal blood loss.     

Sonographic assessment of the lower uterine segment during active labor in women with or without a uterine scar – a prospective study

Objectives: No study thus far has evaluated the LUS thickness in active labor. In this study, we endeavored to assess the LUS during active labor.

Methods: Using transabdominal sonography in the mid-sagittal position with a full urinary bladder, the thickness of the LUS was measured during active labor phase in women with or without a history of a previous cesarean section.

Results: A total of 28 women with a previous cesarean delivery were compared to 29 women without a history of uterine surgery. The median LUS was significantly thinner in women with a uterine scar both during (4 versus 5?mm, p?=?.001) and between contractions (5 versus 7?mm, p?=?.011). Paired comparison of LUS thickness between and during contractions within each group showed that thinning of LUS during contraction was significant for both the previous CS group (p?p?Conclusions: In this study, we characterized for the first time the LUS during active labor. We found that LUS was significantly thinner in women after a previous CS and that the LUS was significantly thinner during contraction.     

Bakri balloon versus condom-loaded Foley’s catheter for treatment of atonic postpartum hemorrhage secondary to vaginal delivery: a randomized controlled trial

Objective: To assess the efficacy and safety of condom-loaded Foley’s catheter versus Bakri Balloon in the management of primary atonic post partum hemorrhage (PPH) secondary to vaginal delivery.

Study design: This study was single blinded randomized controlled trial conducted at Assiut Woman’s Health Hospital, Egypt in the period between October 2014 and December 2015. It Comprised 66 women with primary atonic PPH following vaginal delivery. Eligible participants were randomly assigned to Bakri balloon (group A) or condom-loaded Foley’s catheter (group B). The primary outcome was the success of tamponade to stop the uterine bleeding without additional surgical interventions. Secondary outcomes included time between insertion and stoppage of the bleeding, the amount of blood transfusion and maternal complications.

Results: Both treatment modalities successfully controlled the primary atonic PPH without a statistically significant difference [30/33(91.0%) and 28/33(84.84%), p?=?.199; respectively]. However; Bakri balloon required shorter time to stop the uterine bleeding (9.09?min vs. 11.76?min, p?=?.042; respectively). There was no statistically significant difference between both groups regarding postpartum maternal complications, the vital signs, urine output, hemoglobin and hematocrit levels from before to after tamponade insertion.

Conclusions: Condom-loaded Foley’s catheter is as effective as Bakri balloon in the management of primary atonic PPH following vaginal delivery but requires a significant bit longer time to stop the attack.