I read with interest the excellent review by Georgiou1 on balloon tamponade in the management of postpartum haemorrhage. The ingenious idea of a condom catheter2 is particularly appealing to obstetricians and midwives practicing in developing countries with no access to Bakri and Rusch balloons or Sengstaken–Blakemore tubes. There are, in my opinion, two drawbacks to the condom catheter. First, as the condom is filled with fluid, its wall becomes so stretched that it becomes ‘wobbly’– which may hinder its performance in exerting a tamponade effect on the uterus. Second, the condom catheter does not allow drainage of the uterine cavity. This is why I suggest the following two modifications.
First, I suggest that three condoms (instead of one) are fitted, one over the other, to a urinary catheter in the same way as described by Akhter et al.2 The distal ends of the three condoms are then tied together with a suture/tie to the shaft of the catheter. The ‘trio’ condom catheter is then inserted into the uterine cavity and inflated with saline in the usual way (as described by Akhter et al.2). The extrauterine end of the catheter is then tied to prevent backflow of saline. The ‘trio’ condom catheter can easily accommodate more than two litres of fluid and provides a firm, ‘non-wobbly’, fluid-filled structure to produce the much-desired tamponade.
Second, I suggest that, before the introduction of the ‘trio’ condom catheter into the uterus, a separate, size 16 rubber urinary catheter is inserted into the uterine cavity to allow for drainage of blood. This separate catheter can be attached to a plastic bag or glove to measure the blood loss. The vagina is then packed with ribbon gauze to prevent slippage of the two catheters out of the uterus.