Study Finds Panicker's Cannula Offers Effective Bleeding Control in Atonic Postpartum Hemorrhage

WHO suggests a series of measures as ‘first-line treatment for women’ who start bleeding. Management consists of a series of quick, progressively more invasive procedures until bleeding stops. Fluid resuscitation, placental removal, bimanual uterine compression, tranexamic acid, uterotonics, suturing lower genital tract injury, replacement of blood products, laparotomy, balloon tamponade, stepwise uterine devascularization, uterine compression sutures, and hysterectomy are some of these interventions.

Primary PPH and secondary PPH are the two types of PPH. Secondary PPH occurs beyond 24 hours and can occur up to 6 weeks after delivery. Atonic PPH can also be caused by certain risk factors, such as prolonged labor, pregnancy-related hypertension, accidental hemorrhage, anemia, polyhydramnios, and large newborns.

Surgical procedures are not often available limited resource settings and are linked to a higher risk of morbidity and mortality. Uterine compression sutures, such as B-Lynch brace sutures are simple and practiced by obstetricians worldwide. Total or sub-total emergency peri-partum hysterectomy’(EPH) is a procedure used as last option when all conservative methods have failed to manage atonic PPH and are associated with high maternal morbidity and mortality.

Effective non-surgical treatments are essential for managing refractory PPH to prevent surgery & treat patients where surgery is not a feasible option. In recent years, number of intra-uterine devices available for treating refractory hemorrhage has rapidly increased. According to WHO, use should only be permitted in situations where care escalation and monitoring are feasible.

Two types of uterine tamponade devices are available for treatment of PPH i.e. Uterine Balloon Tamponade (UBT) and Uterine Suction Tamponade (UST). UST devices like Panicker’s suction cannula due to their similar mechanism of action as that of physiological uterine retraction, may be regarded as a biologically plausible alternative for the treatment of unresponsive PPH.

This study was conducted to study efficacy and safety of Panicker Vacuum Retraction Cannula as compared to Intra-uterine Foleys Balloon Tamponade in management of atonic PPH and to compare the amount of blood loss between the two in atonic PPH after vaginal deliveries and caesarean sections.

Hospital- based study, 100 patients were recruited with 50 patients in each group & randomly selected for Panicker’s (Uterine suction Tamponade) group or Foley’s Balloon Tamponade (Uterine balloon Tamponade) group designated as Group P & Group-B respectively.

In Panicker’s Group, 60% patients (n=30) experienced blood-loss between 150–200 mL while in Balloon Tamponade group, significantly higher proportion 40% (n=20) patients experienced blood-loss between 201–250 mL,(P=0.001).

In Group P, 78%(n=39) and in Group B 62% (n=31) patients had hemoglobin deficit of less than 2.5 g/dl.

In Group P, 24% (n=12) while in Group B, 48% (n=24) cases required blood transfusion, (p value =0.012). In Group P, 78% (n=39) had bleeding successfully controlled as compared to 46% (n=23) participants in Group B, (P<0.001).

In Group P, 8% (n=4) participants required application of hemostatic sutures while.

In Group B, 26% (n=13) needed it, (p=0.033).

In Panicker’s group, 8% (n=4) participants required ligation of anterior division of internal iliac arteries as compared to Group B, 14% (n=7) participants.

In Group P, 6% (n=3) while in Group B, 14% (n=7) patients underwent hysterectomy.

Post-partum hemorrhage continues to be a major contributor to maternal morbidity and mortality, particularly in low-resource settings where access to advanced medical interventions is limited. Atonic PPH, caused by failure of uterus to contract effectively after delivery, represents the most common variant. When first-line pharmacologic therapies fail, timely and effective second-line interventions are crucial in achieving hemostasis and preserving uterine integrity.

This study reflects superior physiological compatibility and efficacy of vacuum-assisted Uterine Suction Tamponade using Panicker’s cannula as compared to uterine Foley’s Balloon Tamponade in cases of atonic PPH. Panicker’s group demonstrated significantly higher success rate in achieving haemostasis with reduced blood loss, lower Hb% deficit, lesser need for blood transfusion and application of uterine haemostatic sutures as compared to UBT group.

Although the differences in surgical interventions such as ligation of anterior division of internal iliac arteries and hysterectomy did not reach statistical significance, these findings favoured Panicker’s cannula method in reduced requirement of these procedures. Importantly, in this study, several demographic and clinical variables were unevenly distributed between the two groups due to random selection of patients such as higher number of patients with High risk pregnancy, cesarean section and labour induction/augmentation in Foley’s balloon Tamponade group – which may have partially influenced outcomes. Despite these confounding factors, the consistent better results in Panicker’s group across a range of parameters underscore the device’s robustness and reliability in real-world settings. At present, intra-uterine Foley’s balloon Tamponade (UBT) remains a widely accepted, practiced and effective method in obstetric practice especially in low resource settings yet UST with Panicker’s cannula offers an equally cost-effective yet more physiological and effective approach with faster intra-uterine blood evacuation, superior bleeding control, shorter time to application & lesser technical skills requirement and seems to be a promising alternative in management of atonic PPH in future.

Source: Zadeza et al. / Indian Journal of Obstetrics and Gynecology Research 2026;13(2):398–405