Condoms useful in arresting post-delivery bleeding

Rita Dutta - Mumbai

Ever heard of condoms being used to stop uterine bleeding of women suffering from post-partum haemorrhage (PPH)? Well, this is exactly what obstetricians of JJ, Cama and St George hospitals are practising since 1985.

A simple assembly of three easily available components costing just about Rs 20 to generate hydrostatic pressure within the uterus is used to save the lives of women who fail to respond to drugs administered to stop severe bleeding.

INNOVATIVE: Dr Suvarna Khadilkar, Dr Vivek Bobade and Dr K S Shivkar demonstrate the use of condom to stop post partum bleeding

This innovative technique, which is not used in any other part of the world, is the brainchild of Dr K S Shivkar, retired associate professor of JJ hospital. Says Dr Shivkar, who today witnesses his students and other gynaecologists practising his technique with success, “For a woman suffering from PPH, the only option sometimes left to a gynaecologist is to remove the uterus. Surgery by a vascular surgeon can also be performed, which requires sophisticated equipment and may not be immediately performed because of the tremendous amount of bleeding. The patient can go into a state of shock or even die when the doctor is unable to control the bleeding.” That’s when Dr Shivkar hit upon the idea of using a condom to exert hydrostatic pressure on the uterine wall.

The technique, popularly known as Shivkar’s balloon pack, involves tying a condom to the intravenous drip of a saline bottle with the help of a band. The gynaecologist inserts the condom into the uterine cavity using his hand and packs the lower portion of the vagina by a roller gauze to prevent the condom from slipping out. The condom is then filled with the saline kept 60 to 70 cms above the abdomen. The balloon obliterates all dead spaces and pressurises the uterovaginal canal to stop bleeding. The bleeding generally stops after 15 minutes, but the pressure is exerted from six to twenty four hours. The condom is emptied by adjusting the height of the saline before it is taken out of the uterus.

The whole pack costs Rs 21, which includes a condom (Re 1), IV drip (Rs 10) and a saline bottle (Rs 10). From 1985 to 2002, Shivkar had used this device on more than 100 women with uncontrolled obstetric haemorrhage, out of which more than 75 per cent stopped bleeding, 20 per cent showed partial bleeding and five per cent failed. Shivkar’s pack is also used for bleeding related to abortion and repositioning of inverted uterus.

Obstetricians urge that Shivkar’s pack needs to be propagated all over the country to reduce the high prevalence of PPH, the leading cause of maternal deaths in India. According to the Federation of Obstetrics and Gynecological Society of India (FOGSI), obstetric haemorrhage is responsible for 38.2 per cent of maternal deaths per 1,000 deliveries, out of which 35.2 per cent is due to PPH. Around five to eight per cent of women fail to respond to drugs and hence require additional support.

According to Dr Suvarna Khadilkar, associate professor of obstetrics and gynaecology at JJ hospital, Shivkar’s technique has replaced the conventional method of packing, that is inserting a gauze inside the uterus to soak the oozing blood. “The traditional method is a tedious process for the gynaecologist, whereby intra-uterine manipulation is required to insert the gauze. It requires anaesthesia and may even lead to tear of the uterine wall. In rural areas, where the ‘dais’ (traditional birth attendants) use ’saris’ instead of gauze to do the packing, the traditional method can lead to serious complications,” says Dr Khadilkar. Though some hospitals might have equipment to insert the gauze inside the uterus, either medicos are not trained to use them or the equipment is not maintained properly, adds Dr Shivkar.

A certain section of the medical community had questioned Shivkar’s procedure in the initial years. “Condom is non-porous, available everywhere and cheap,” reasons Dr Shivkar. He brushes aside fears of rupturing of condom when being inflated saying, “It is the best balloon. It can expand to 20 litres and to stop bleeding one does not need to inflate it beyond one litre.”

Slowly and steadily, Shivkar’s pack is gaining popularity. Says Dr Duru Shah, president, Mumbai Obstetrics and Gynaecological Society (MOGS), who has used this technique on five patients with success, “I wish that this technique is marketed so that more gynaecologists use it.” Adds Dr Vivek Bobade of Cama hospital, “The technique is convenient to use and, most importantly, it has saved lives whenever I used it.”

Dr Shivkar has refused to patent his invention. “Patenting would increase the cost of the technique many fold and would make it unaffordable to the poor rural woman,” says Dr Shivkar.

Dr Shivkar is optimistic that his technique would gain recognition with FOGSI, which in the 80s had refused to publish his technique in its scientific journal, now agreeing to print an article jointly written by him and Dr Khadilkar in the June, 2003 issue.