How Effective is Intrauterine Balloon Tamponade for Severe Postpartum Hemorrhage
BACKGROUND AND PURPOSE:
90% of maternal deaths from postpartum hemorrhage (PPH) are considered preventable
Recent publications report balloon tamponade success rates to be approximately 80%
Previous studies did not include control groups
Revert et al. (Obstetrics & Gynecology, 2017) compared the rates of invasive procedures for postpartum hemorrhage between a perinatal network that uses intrauterine balloon tamponade vs another that does not
Population-based retrospective cohort study (2011 – 2012)
Patients: All women who gave birth in two French perinatal networks
Both units used standardized French national PPH guidelines
Intervention cohort incorporated the use of intrauterine balloon tamponade for
PPH due to uterine atony unresponsive to prostaglandin E2 analog after vaginal delivery or
Delayed PPH after cesarean delivery
If PPH remained uncontrolled following noninvasive treatments, invasive procedures were initiated, including
Outcomes were quantified based on discharge data from the national French medical information system
General and obstetric characteristics were included in two separate models according to mode of delivery to estimate the independent association of the network with invasive procedures
In the balloon tamponade cohort, there was
A significantly lower proportion of women undergoing at least one invasive procedure (3.0/1,000 vs 5.1/1,000; P<.01)
A significantly lower proportion of women undergoing arterial embolization (0.2/1,000 vs 3.7/1,000; P<.01)
After controlling for potential confounding factors
The risk of an invasive procedure among women who delivered vaginally remained significantly lower with the use of balloon tamponade for vaginal birth (adjusted odds ratio [OR] 0.14; 95% CI 0.08–0.27) but not cesarean (adjusted OR 1.19; 95% CI 0.87-1.61)
The authors recognize study limitations including (1) the lack of coding for compression suture and (2) the two cohorts were not identical in application of anti-PPH invasive procedures
The results of this large population cohort study confirm previous literature
Intrauterine balloon tamponade for PPH following vaginal delivery is associated with lower use of invasive procedures
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This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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