Insight

How Uterine Balloon Tamponade Strengthens PPH Response

Postpartum haemorrhage (PPH) is often one of the most time-critical emergencies in maternity care. For most women and birthing people, a structured first‑response bundle is enough to bring bleeding back under control. 

A subset of cases, however, do not respond adequately to these measures. At that point, clinical teams are required to escalate rapidly, often towards procedures that may sacrifice future fertility. The way this escalation is managed has significant implications for maternal outcomes.

Uterine balloon tamponade (UBT) is recommended by WHO as a uterus-sparing option for atonic PPH when first-line treatment has been unsuccessful. When deployed in a timely and systematic way, UBT can provide effective intrauterine tamponade, stabilise bleeding without the need to progress to more invasive surgical interventions.

Where Uterine Balloon Tamponade fits in PPH pathways

Most PPH protocols are built around a staged response: early recognition, prompt activation of a multidisciplinary team, delivery of a standardised first-line bundle, and then structured escalation if bleeding persists.

The latest WHO guidelines, published in October 2025, place new emphasis on diagnosing PPH through objective measurement of blood loss, and on delivering the first-line bundle (uterotonics, uterine massage, tranexamic acid, fluid resuscitation and repair of obvious genital tract trauma) rapidly and concurrently once diagnosis is confirmed.

Where examination suggests that uterine atony is still the main cause, and there is no strong suspicion of uterine rupture or significant retained tissue,  guidelines from the World Health Organisation and Royal College of Obstetricians and Gynaecologists recommend intrauterine balloon tamponade as the next step.

Therefore, UBT provides a uterus-sparing mechanical option for ongoing atonic PPH that has not responded to first-line treatment. It is usually deployed on the labour ward or in theatre with the aim of compressing the uterine cavity and stabilising the situation before committing to laparotomy, compression sutures, arterial ligation or hysterectomy.

If bleeding is controlled following balloon placement, more invasive intervention may be avoided. Where bleeding continues, teams should escalate promptly in line with the local PPH pathway.

Recognising the right moment for UBT

Timely escalation is important in PPH management, and UBT should not be allowed to delay other necessary interventions where bleeding remains uncontrolled.

UBT should be considered as soon as it is clear that a complete first‑line bundle has not achieved sustained control of bleeding from a soft, enlarged uterus. Many services now define this in concrete terms, for example:

At this point, delaying escalation risks further haemodynamic compromise and more extensive downstream intervention.

Systematic reviews report success rates of around 86% for UBT in the conservative management of PPH. This supports the established role of UBT within structured escalation pathways for PPH that has not responded to first-line management.

Preparing teams to use UBT

As the latest WHO implementation guidance notes, effective PPH care depends not only on having evidence-based interventions available, but on ensuring teams are trained, equipped, and supported to implement them consistently.

Clarifying indications and contraindications

Teams need a shared understanding of the clinical scenario in which UBT is appropriate. It is equally important to be clear about when other interventions should take priority, such as suspected uterine rupture or inversion, or placenta accreta spectrum that has not been removed. 

Ensuring device familiarity

Clinicians and midwives should be confident with the specific uterine balloon system stocked in their unit. That includes knowing where it is kept, how to assemble it rapidly, which inflation medium to use, typical inflation volumes, and how to secure and monitor the catheter once in place. 

Embedding UBT in simulation and debrief

UBT should feature routinely in multidisciplinary PPH simulations, rather than as an occasional add‑on. Realistic drills allow staff to rehearse both the technical steps of insertion and inflation and the communication needed with colleagues, the woman or birthing person and their family. 

Following real PPH events, structured debriefs that include discussion of whether UBT was considered, and at what point, help refine practice over time.

Service‑level benefits of Uterine Balloon Tamponade

When uterine balloon tamponade is integrated systematically into PPH pathways, its impact is intended to be felt beyond the individual emergency. By controlling atonic bleeding earlier, UBT aims to reduce reliance on major surgical procedures undertaken purely for haemostasis, in turn easing pressure on theatre and anaesthetic capacity and lowering demand for blood products and critical care beds.

For clinical leaders and managers, this rationale aligns with broader goals around maternity safety and cost‑effectiveness. A relatively low‑complexity, uterus‑sparing intervention that can be deployed rapidly on the labour ward or in theatre offers an opportunity to improve outcomes while supporting more sustainable use of resources.

Equip your practice with UBT

The Postpartum Balloon from Maternity by Kimal uses the established principle of uterine balloon tamponade to support the conservative management of PPH when first-line treatment has been unsuccessful.

To learn more about the Postpartum Balloon and how it’s helping to advance maternal care, visit the product page or contact the Maternity by Kimal team for more information.

Postpartum Balloon product page