Postpartum haemorrhage (PPH) is the most common cause of maternal death worldwide and causes significant maternal morbidity in developing countries. According to WHO, PPH occurs in 2-6% of women after birth and accounts for 25% of all maternal deaths.¹ In India maternal deaths due to PPH is as high as 30%. Approximately 110,000 women die annually worldwide from PPH, and more than 50% of these deaths occur within first 24hrs post-partum.² The six leading causes of maternal mortality are hemorrhage, eclampsia / preeclampsia, ruptured uterus, abortion & prolonged obstructed labor.

Causes of primary PPH are uterine atony, retained placenta, traumatic PPH, abnormal placentation, coagulation disorder, mixed variety, other obstetric factors (eg. previous history of PPH, multiparity).

Management of primary atonic PPH consists of stepwise approach: Initial resuscitation, rule out other causes of PPH, injection of oxytocics & tranexamic acid, sublingual misoprostol tablets, non-surgical methods (uterine massaging & bimanual compression, intra-uterine tamponade with condom / Foley’s catheter / Sengstaken-Blakemore tube), external aortic compression & non-pneumatic antishock garments, uterine artery & internal iliac artery embolization, surgical methods (stepwise uterine devascularisation, internal iliac artery ligation, compression sutures & hysterectomy).³

In resource-limited setting, new, effective treatments are needed that can be applied in lower-level, non-surgical facilities, where the great majority of births take place.

Recently, Foley’s catheter tamponade has been widely used in management of PPH unresponsive to standard management. It is a simple procedure which is readily available, can be performed by junior doctors and paramedical staffs under supervision, and has the advantages of immediate results, low cost and reduced morbidity. Foley’s catheter is a cheap and easily available alternative to catheters like Sengstaken Blakemore tube and Bakri balloon which are commonly used for tamponade in post-partum haemorrhage. Besides being used as a therapeutic intervention it helps obstetrician to identify which women will require laparotomy. Intrauterine balloon may also be used as a temporizing measure while awaiting transfer or to resuscitate her.

The aim of this study is to determine efficacy of intrauterine foley’s catheter tamponade to arrest bleeding in cases of atonic postpartum haemorrhage (PPH) unresponsive to uterotonics in low resource settings as a simple, low cost and readily available method. The objective of this study is to evaluate the effectiveness of intra-uterine foley’s catheter tamponade in terms of: Improvement of pallor, occurrence of any post-procedural infection, severity of pallor and estimated blood loss, haemoglobin and haematocrit deficit, need for blood transfusion, maternal morbidity.

This is a prospective, interventional study conducted at a tertiary care centre in Kolkata from 31st April 2022 to 30th October 2023. The inclusion criteria of the study were patients diagnosed with PPH due to uterine atony with failed medical management following vaginal delivery. Exclusion criteria were coagulopathy, traumatic PPH, retained products, uterine fibroid, uterine anomaly or chorioamnionitis & placenta previa. All the records of eligible candidates such as age, socio economic status, parity, booked case, singleton or multiple pregnancy, gestational age at delivery, history of previous caesarean section, history of PPH in previous pregnancies, anemia status & pre-existing haemoglobin level, haemoglobin level after PPH, fall in haemoglobin level, mode of onset of labour, mode of delivery, place of delivery, prolonged labour, amount of PPH, PPH to tamponade interval, tamponade volume, tamponade to haemostasis interval, birth weight of babies, need for blood transfusion, number of PRBC transfusions, post-procedural infection were noted in a Microsoft Excel spreadsheet (version: Office 2021, Windows 10) during the study period. Data was obtained during management of atonic PPH in the labour room and during further follow-up for every case. Data thus collected was statistically analysed using measures like mean, median and standard deviation. Institutional ethics approval was obtained from the institutional ethics committee.

The sample size for this study was calculated as 140 as per the formula n = (Zα/2 )² pq/l² where n = sample size, p = prevalence rate of intrauterine foley’s catheter tamponade in management of atonic PPH, l = margin of error (taking it as 3%) and taking 10% as non-responder’s rate.

As per this study, the mean age of the study population was 24.75 years, out of which 54.28% were primiparas, 59.28% belonged to lower socio-economic status, 95.71% were booked cases, 91.42% were singleton pregnancies, 30.71% had preterm, 69.29% had term & 12.85% had post-dated pregnancies (Table 1).

89.28% did not have previous history of PPH, 75.71% had moderate anemia, 59.29% underwent spontaneous vaginal delivery, 92.85% received active management of third stage of labour & 75.02% had moderate PPH (Table 2).

67.42% patients had PPH – tamponade interval of 30 – 60 minutes, 55.71% had tamponade – hemostasis interval of 5 – 10 minutes & 89.28% did not require surgical interventions. The final outcome of the study showed that 92.14% patients were discharged under stable conditions, 5.71% developed sepsis, 1.42% developed acute kidney injury & 0.71% maternal mortality (Table 3, Figure 1).

Table 1: Distribution of the Age, Socio-Economic Status, Booked Cases, Parity, Gestation & Gestational Age

Table 2: Distribution Of Previous History Of PPH, Anemia & Baseline Hb (Gm%), Mode Of Delivery, AMTSL & Volume Of PPH (Ml)

Table 3: Distribution of PPH – Tamponade Interval (Mins), Tamponade – Hemostasis Interval (Mins) & Need for Surgical Interventions

This study evaluated the effectiveness of intrauterine tamponade using a Foley’s catheter for controlling primary atonic postpartum haemorrhage (PPH) following vaginal delivery. Although balloon devices such as the Bakri or Sengstaken–Blakemore tubes have been widely studied, reports on Foley’s catheter use remain relatively few, particularly in low-resource settings.

The mean age of patients was 24.75 ± 5 years, with most between 20–25 years, similar to the findings of Hanumant Vitthalappa Nipanal and Soubhagya R Talawar⁴, indicating that PPH commonly affects younger women. A majority (59.28%) belonged to the lower socioeconomic class, emphasizing the role of poor nutrition and anaemia in adverse maternal outcomes. Most patients (95.71%) were booked, contrasting with the higher failure rates among unbooked women reported by Rubina Akhtar and Irum Afzal⁵, highlighting the importance of antenatal care.

Primiparity was common (59.28%), and one-third had instrumental deliveries, which increase the risk of uterine atony. Twin gestation (8.58%) and preterm delivery (30.71%) were also frequent contributors. Anaemia was almost universal, with 80.71% moderately anaemic, a factor known to increase transfusion needs and infection risk.

Intrauterine Foley’s catheter tamponade successfully controlled bleeding in 89.28% of patients, with haemostasis achieved within 5–10 minutes in most cases. Comparable success rates were reported by Hanumant Vitthalappa Nipanal and Soubhagya R Talawar⁴ (95.8%) and Rubina Akhtar and Irum Afzal⁵ (93.9%). Among 15 failures, seven required stepwise devascularization and eight underwent obstetric hysterectomy. One maternal death occurred (0.71%), and sepsis developed in 5.71%, similar to rates reported by Sudha R and Anjali R⁶.

Blood transfusion was required in 54.28% of patients, with a mean haemoglobin drop of 1.2 g/dL, reflecting pre-existing anaemia and blood loss prior to tamponade.

Overall, the results confirm that intrauterine Foley’s catheter tamponade is a rapid, effective, and low-cost intervention for atonic PPH. It is simple to use, minimally invasive, and particularly valuable in peripheral or resource-limited settings where timely surgical support may not be available.

This study demonstrates that intrauterine Foley’s catheter tamponade is a safe, effective, and readily available method for controlling severe atonic postpartum haemorrhage unresponsive to pharmacological therapy. It offers rapid haemostasis, minimizes the need for invasive surgical interventions such as hysterectomy, and reduces maternal morbidity and hospital stay. The procedure is inexpensive, simple to perform, and suitable for use in low-resource or peripheral settings, even by trained birth attendants. Early application, combined with aseptic precautions and antibiotic prophylaxis, further improves outcomes. Although larger studies are needed to validate these findings, Foley’s catheter tamponade remains a valuable, life-saving option in the stepwise management of atonic PPH. FUNDING Nothing such. CONTRIBUTION TO AUTHORSHIP PKS & AB wrote the first draft of the paper. NP statistically analyzed the data. PKS, AB, NP & RB edited and revised the article, and all the authors approved the final draft. COMPETING INTERESTS None declared. PATIENT CONSENT Obtained.

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