No abstract

INTRODUCTION: Mortality from postpartum hemorrhage (PPH) is decreasing in the United States, however the incidence of PPH is actually increasing. Stage 3 PPH, or estimated blood loss greater than 1500 mL as defined by the California Maternal Quality Care Collaborative, often requires second-line intervention including uterine tamponade with Bakri balloon, dilation and curettage, uterine artery embolization, hemostatic sutures, compression sutures, or ultimately hysterectomy. Although guidelines exist for management of PPH, the timing and use of second-line therapies is less standardized and varies based on provider experience. We sought to determine whether timing of uterine tamponade, generally the first line treatment of ongoing PPH, is associated with morbidity among patients who experienced stage 3 blood loss. METHODS: This is a retrospective chart review of women with stage 3 PPH at a single academic institution. Patient demographics, delivery information, timing of second-line interventions and transfusion, and morbidity were abstracted from the electronic medical record. Morbidity included ICU admission, hemorrhagic shock, disseminated intravascular coagulopathy, renal failure, and endometritis. RESULTS: Between 2007 and 2015, 267 patients experienced a stage 3 PPH. Second-line therapies were used in 116 patients, with Bakri balloon being the most commonly used intervention. 28 patients had Bakri balloon placement within 30 minutes of PPH, compared to 19 patients who had placement after 30 minutes. Women who received a Bakri within 30 minutes of onset of PPH experienced lower composite morbidity. CONCLUSION: Placement of a Bakri balloon within 30 minutes of the onset of PPH may decrease morbidity in patients with stage 3 PPH.