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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