What is bimanual uterine tamponade?

Bimanual Uterine Tamponade: Definition and Clinical Application

Bimanual uterine tamponade is a manual technique used to control postpartum hemorrhage by applying simultaneous pressure to the uterus from both inside and outside the body, compressing the uterine walls to reduce bleeding and stimulate contraction. 1

Technique and Mechanism

• Bimanual uterine tamponade involves one hand placed vaginally inside the uterus (internal compression) while the other hand applies counter-pressure externally on the abdomen over the uterine fundus 1
• The technique works by:
  • Directly compressing bleeding vessels at the placental implantation site 1
  • Stimulating uterine contractions through mechanical pressure 1
  • Creating a tamponade effect that reduces blood flow to the uterus 1

Clinical Application

• Bimanual compression is recommended as an immediate non-pharmacological intervention for postpartum hemorrhage management, alongside fluid resuscitation and uterotonic medications 1
• It is particularly valuable in settings with limited resources or when waiting for additional interventions 2
• Standard technique involves:
  • One provider placing a fist inside the vagina against the anterior lower uterine segment 3
  • Simultaneously applying counter-pressure with the other hand on the abdomen 3
  • Assessing for cervical motion tenderness, which may indicate pelvic infection 3

Enhanced Two-Provider Technique

• Research demonstrates that a two-provider technique is more effective and sustainable than single-provider compression 2
• In the two-provider approach:
  • One provider maintains internal pressure against the lower uterine segment with one hand 2
  • A second provider applies external pressure to the uterine fundus using both hands 2
  • This technique allows for full uterine compression for extended periods (up to 5 minutes or longer) 2

Efficacy and Limitations

• Individual providers typically fatigue within 150 seconds when performing bimanual compression alone 2
• Team-based bimanual compression allows for sustained pressure for at least 5 minutes, potentially increasing the likelihood of controlling hemorrhage 2
• When bimanual compression fails to control bleeding, additional interventions are required, such as:
  • Intrauterine balloon tamponade 1
  • Uterine compression sutures 1
  • Arterial embolization or ligation 1
  • Hysterectomy as a last resort 1

Clinical Considerations

• Bimanual compression should be initiated promptly when postpartum hemorrhage is identified, particularly for uterine atony 1
• The technique should be performed while simultaneously administering uterotonic medications (oxytocin 5-10 IU) 1
• Vital signs monitoring during compression is essential to assess response to treatment 1
• In cases of severe hemorrhage, early activation of massive transfusion protocol is recommended if blood loss exceeds 1500 mL 1

Bimanual uterine tamponade represents a critical first-line intervention for managing postpartum hemorrhage, especially in resource-limited settings where advanced interventions may be delayed or unavailable.