Grand Rounds

What Factors Are Associated with PPH Intrauterine Tamponade Failure?

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

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

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)

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

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