Evaluation of the effectiveness of metreurynters for balloon tamponade

Abstract

Aim: Several devices are used for balloon tamponade. In Japan, metreurynters are widely used for cervical ripening; however, there is little evidence for their use in hemostatic uterine balloon tamponade. This study aimed to assess the non-inferiority of metreurynters as the balloon device for obstetric hemorrhage. Methods: Medical charts of all patients with obstetric hemorrhage of more than 1,000 ml who underwent balloon tamponade with metreurynters were retrospectively reviewed for five years at a tertiary referral university hospital. Results: A total of 89 uterine balloon tamponade cases were identified from medical records. Of these, 66 cases involved term postpartum hemorrhage (PPH) within 24 h after delivery (PPH group) and 23 involved other types of cases (other group), including cesarean scar pregnancy, cervical pregnancy, retained placenta, and others. In the PPH group, the average hemostasis rate was 93.9%, whereas the rate was 91.3% in the other group. Seven cases failed to achieve hemostasis with balloon tamponade only and required additional treatment. There were no adverse events related to balloon tamponade using metreurynters. Conclusions: Metreurynters used for balloon tamponade were non-inferior to Bakri balloons in hemostasis and complication rates, suggesting they are effective and appropriate for the management of obstetrical hemorrhage.

Assessment of extravasation on ruptured uterine artery pseudoaneurysm using contrast-enhanced ultrasonography during uterine balloon tamponade

“…Bleeding points were assessed a few minutes after administering Sonazoid. A Fuji-Metro balloon (Fuji Latex, Tokyo, Japan), 24 originally designed for cervical ripening before inducing labor, was then inserted at the bleeding point in the uterine cavity and inflated until extravasation ceased. The off-label use of the Fuji-Metro balloon was approved by the Juntendo University Hospital Ethics Committee (#18-040).…”

A minimally invasive hemostatic strategy in obstetrics aiming to preserve uterine function and enhance the safety of subsequent pregnancies

“…Recent studies have shown the success rates of hemostasis to be in the range of 86-93.9%; success rates in our clinical experience are also high, at approximately 93.9%. 19) A clinical comparison of results obtained before and after the introduction of balloon tamponade revealed a decrease in the frequency of employing surgical hemostatic procedures and TAE in cases of vaginal delivery, indicating the effectiveness of balloon tamponade. 17) Currently, balloon tamponade is recommended in the guidelines of the World Health Organization (WHO) and by major academic societies such as the International Federation of Gynecology and Obstetrics (FIGO), American College of Obstetricians and Gynecologists (ACOG), Royal College of Obstetricians and Gynecologists (RCOG), and Society of Obstetricians and Gynaecologists of Canada (SOGC).…”

“…14) Even in cases of massive hemorrhage associated with cervical pregnancy in early gestation or ectopic pregnancy in a cesarean section scar, placement of a uterine cervix dilation balloon (Minimetro, Soft Medical Co., Ltd.; Cook double balloon, Tokibo Co., Ltd.), with infusion of a small amount (15-40 ml) of physiological saline, has proven to be effective. 19) However, balloon tamponade can be problematic as the balloon may become dislodged from the uterus, and blindly pressing on the bleeding point may fail to achieve hemostasis. To solve these problems, infusion of water into the balloon while confirming the bleeding point with an ultrasonic contrast agent has been proposed.…”

A Minimally Invasive Hemostatic Strategy for Cesarean Scar Pregnancy and Cervical Pregnancy

“…This is a hemostatic technique used for overall uterine hemorrhage in the puerperal period including atonic bleeding, incomplete cervical laceration, crush syndrome, and bleeding from the separation surface of placenta previa. Balloon tamponade is also effective and useful for uterine hemorrhage from CSP and cervical pregnancy (Figure 4) [46]. In an emergency, insertion and placement of the balloon are technically easy and can be performed expeditiously; this technique is simple and minimally invasive.…”

“…Then, ultrasoundguided D&C to evacuate the gestational sac is performed a week later after MTX therapy. Bleeding point during D&C could be found by contrast-enhanced ultrasonography, and a cervical ripening miniballoon (Minimetro ® ) could be inserted at the bleeding point and inflated until bleeding stops [46,49]. If bleeding continues, TAE or laparoscopic wedge resection would be performed as soon as possible.…”