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Grand Rounds

What Factors Are Associated with PPH Intrauterine Tamponade Failure?

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BACKGROUND AND PURPOSE:

  • Gibier et al. (Obstetrics & Gynecology, 2022) identified factors associated with intrauterine tamponade failure for postpartum hemorrhage (PPH) after vaginal or cesarean delivery

METHODS:

  • Population-based cohort study (2019)
    • French national hospital database
  • Population
    • All women in France who received intrauterine tamponade for PPH
  • Exposures
    • Intrauterine balloon tamponade | Guidelines allow for use of tamponade following failure of medical therapies and prior to surgery or interventional radiology
  • Study design
    • Univariate analyses and multivariate generalized logistic regression used to determine risk factors
  • Primary outcome
    • Intrauterine tamponade failure: Defined as the use of a second-line method (uterine artery embolization, conservative or radical surgery, or death) within 7 days

RESULTS:

  • 39,193 patients
    • Received intrauterine tamponade: 4.5%
  • Effectiveness rate of intrauterine tamponade: 88.9%
  • Second-line method needed: 11.1%
  • Patients with tamponade failure were more likely to have
    • Higher maternal age
    • Lower mean gestational age
  • Failure occurred more frequently in the following clinical scenarios
    • Placental abnormalities | Preeclampsia | Cesarean birth | Uterine rupture
  • Intrauterine tamponade failure was independently associated with
    • Cesarean birth
      • Adjusted odds ratio (aOR) 4.2 (95% CI, 2.9 to 6.0)
    • Preeclampsia
      • aOR 2.3 (95% CI, 1.3 to 4.0)
    • Uterine rupture
      • aOR 14.1 (95% CI, 2.4 to 83.0)

CONCLUSION:

  • Risk factors independently associated with failure of Intrauterine tamponade for PPH included cesarean delivery, preeclampsia and uterine rupture
  • The authors state

In these situations, the management of severe postpartum hemorrhage may be oriented to second-line methods

Learn More – Primary Sources:

Risk Factors for Intrauterine Tamponade Failure in Postpartum Hemorrhage

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Related ObG Topics:

How Effective is Intrauterine Balloon Tamponade for Severe Postpartum Hemorrhage
Antibiotics for Reducing Risk of Endometritis Following Intrauterine Balloon Tamponade
What is the Optimal Duration of Intrauterine Balloon Tamponade?

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