Prognostic factors for the use of intrauterine balloon tamponade in the management of severe postpartum hemorrhage

Kong, Choi Wah; To, William W. K.

doi:10.1002/ijgo.12498

Cited by 31 publications

(36 citation statements)

References 24 publications

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“…4 Treatment strategies include pharmacological measures (eg, oxytocin administration), intrauterine tamponade (eg, Bakri balloon or Sengstaken-Blakemore tube), uterine artery ligation, hysterectomy, uterine compression sutures, and uterine artery embolization (UAE). [5][6][7][8][9][10][11][12] A few publications have shown higher rates of preterm birth, fetal growth restriction (FGR), and placenta accreta spectrum (PAS) among women who became pregnant after UAE for PPH. However, these obstetric outcomes were not investigated with non-UAE cases in these studies.…”

Section: Introductionmentioning

confidence: 99%

<p>Obstetric Outcomes of Pregnancy After Uterine Artery Embolization</p>

Jitsumori¹,

Endo²,

Hara³

et al. 2020

IJWH

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Background: Uterine artery embolization (UAE) is used to treat severe postpartum hemorrhage (PPH). According to a few studies, UAE for PPH was associated with preterm birth, fetal growth restriction (FGR), and placenta accreta spectrum (PAS) in subsequent pregnancies. These previous studies, however, lacked controls, and to the best of our knowledge, no systematic literature reviews have been conducted thus far. We report the results of our retrospective case-control study of pregnancies after UAE at a single center and include a literature review to evaluate the risk of PAS in pregnancies after UAE. Methods: We retrospectively reviewed data from deliveries at our hospital between January 2012 and October 2017. We divided the delivery data into cases with previous UAEs performed for PPH (the post-UAE group) and those without UAEs (the non-UAE group, which included women without previous PPH). We defined PAS as cases in which hysterectomy was performed and pathological examination confirmed the diagnosis. Results are presented as odds ratios (ORs) with 95% confidence intervals (95% CIs). Results: We used data from 3155 patients in this study, of whom 16 patients had undergone UAE (post-UAE group) and 3139 had not (non-UAE group). We found no differences between the groups in terms of frequency of preterm births (12.5% versus 14.2%, respectively; OR, 0.863; 95% CI, 0.218 to 3.414; P = 0.84) or FGR (6.2% versus 10.0%, respectively; OR, 0.602; 95% CI, 0.104 to 3.584; P = 0.61). However, cases of PAS were significantly more common in the post-UAE group (37.5%) than in the non-UAE group (1.2%; OR, 50.303; 95% CI, 17.38 to 145.592; P < 0.01). Conclusion: Our results suggest that previous UAE is a significant risk factor for PAS.

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Section: Introductionmentioning

confidence: 99%

<p>Obstetric Outcomes of Pregnancy After Uterine Artery Embolization</p>

Jitsumori¹,

Endo²,

Hara³

et al. 2020

IJWH

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“…Nevertheless, early timing of intrauterine balloon tamponade during the course of postpartum hemorrhage has been associated with improved maternal outcome, whereas early timing of uterine artery embolization seems to be unrelated to maternal outcome. 19,38 However, in these studies, early timing of intrauterine balloon tamponade in the absence of a control group could also have led to an overestimation of the effectiveness due to the possibility that the use of intrauterine balloon tamponade was not absolutely necessary.…”

Section: Discussionmentioning

confidence: 99%

“…Characteristics considered to be potential confounders for the association between use of intrauterine balloon tamponade or use of uterine artery embolization, or characteristics considered to be risk factors for the occurrence of the primary outcome measure alone, were included as covariates in the propensity score model. 17 Characteristics included as covariates that were available at the moment the clinician decided to use intrauterine balloon tamponade or perform uterine artery embolization were: maternal age, gestational age, parity (nulliparity or multiparity), preeclampsia, multiple pregnancy, prior cesarean birth, mode of birth (vaginal birth or cesarean section), cause of hemorrhage (categorized as uterine atony, retained placenta, abnormally invasive placenta and other causes [composite of placenta previa, placental abruption and uterine rupture due to small numbers]), the presence of coagulopathy (defined as a fibrinogen level ≤2 g/L during bleeding), symptoms of shock (defined as at least one measurement of a systolic blood pressure ≤90 mm Hg and/or heart rate ≥120 beats per minute during bleeding), volume of blood loss at time were selected a priori based on the literature 4,5,7,12,13,[18][19][20][21][22][23] and clinical reasoning. Missing variables were imputed using median and logically derived imputation (see Appendix S2 for the rationale behind the imputation method applied per missing variable).…”

Section: Statistical Analysesmentioning

confidence: 99%

Comparison of outcome between intrauterine balloon tamponade and uterine artery embolization in the management of persistent postpartum hemorrhage: A propensity score‐matched cohort study

Ramler

Henriquez

Akker

et al. 2019

Acta Obstet Gynecol Scand

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Introduction The aim of this study was to compare the outcomes of women who were initially managed by intrauterine balloon tamponade or uterine artery embolization because of persistent postpartum hemorrhage demanding an immediate intervention to control bleeding. Material and methods Propensity score‐matched cohort study including women who had intrauterine balloon tamponade or uterine artery embolization as initial management strategy to control persistent postpartum hemorrhage, that is, refractory to first‐line therapy combined with at least one uterotonic agent. The primary outcome measure was a composite of peripartum hysterectomy and/or maternal mortality. Secondary outcomes measures were total volume of blood loss and total number of packed red blood cells transfused. Results Our 1:1 propensity score‐matched cohort comprised of 50 women who had intrauterine balloon tamponade and 50 women who underwent uterine artery embolization at a blood loss between 1000 and 7000 mL. There was no statistically significant difference in the hysterectomy risk between the two groups (n = 6 in each group, odds ratio [OR] 1.00, 95% confidence interval [CI] .30‐3.34), in total volume of blood loss (median 4500 mL, interquartile range [IQR] 3600‐5400) for balloon vs 4000 mL (IQR 3250‐5000) for embolization, P = 0.382) or in total units of packed red blood cells transfused (median 7 (IQR 5‐10) for balloon vs 6 [IQR 4‐9] for embolization, P = 0.319). Fifteen women (30%) who were initially managed by an intrauterine balloon still underwent uterine artery embolization, of whom one had an embolization‐related thrombo‐embolic event. Maternal mortality occurred in neither of the intervention groups. Conclusions No difference in the risk of peripartum hysterectomy and/or maternal death was observed between women who had intrauterine balloon tamponade and women who underwent uterine artery embolization as an initial management for persistent postpartum hemorrhage. Although this study was underpowered to demonstrate equivalence, our study design provides a framework for future research in which intrauterine balloon tamponade may prove to be a suitable intervention of first choice in the management of persistent postpartum hemorrhage.

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“…All pregnant patients with deliveries in United Christian Hospital from January 2011 to June 2016 who had severe PPH (blood loss > = 1 L) were recruited. These patients were identified from our previous studies [ 15 , 16 ] and their demographic and clinical data were reviewed. Patients who had uterine balloon inserted were compared with those severe PPH patients who were managed solely by uterotonic agents which served as the control group.…”

Section: Methodsmentioning

confidence: 99%

Menstrual and reproductive outcomes after use of balloon tamponade for severe postpartum hemorrhage

Kong

2018

BMC Pregnancy Childbirth

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BackgroundThe use of intrauterine balloon tamponade to manage postpartum hemorrhage is increasing. However, there is lack of studies on the menstrual and reproductive outcomes after such treatment. The purpose of this study is to explore the menstrual and reproductive outcomes for patients who had been managed by intrauterine balloon tamponade for severe postpartum hemorrhage in her index pregnancy.MethodsAll patients who had delivered in United Christian Hospital from January 2011 to June 2016 with severe postpartum hemorrhage (PPH) (blood loss> = 1 L) were identified by the labour ward delivery registry and a comprehensive obstetric database. Patients who had intrauterine balloon tamponade inserted were compared with those managed solely by uterotonic agents as controls. Patients who had hysterectomy or additional procedures performed, such as compression sutures or uterine artery embolization were excluded from both groups. A questionnaire on menses, fertility and reproductive outcomes was mailed to both groups of patients. Those that had not replied within 4 weeks would receive a telephone survey.ResultsA total of 39 patients in the balloon tamponade group and 161 patients in the control group were recruited, which represented 87.0% of all eligible patients within the study period. The median follow up period was 45 months. All patients in the balloon tamponade group had return of menses after delivery. The majority of the patients (87.2%) in the balloon tamponade group had normal menstrual patterns in the 12 months after the index delivery as well as in the most recent 12 months. After excluding the patients with contraception, the subsequent pregnancy rate was 42.9% (9/21) in the balloon tamponade group compared to 45.9% (28/61) in the control group (p = 0.81). Among the 9 subsequent pregnancies in the balloon tamponade group, there were two miscarriages, one scar pregnancy, one induced abortion, while the remaining five were normal pregnancies with full term deliveries without intrauterine growth restriction. The majority of patients replied that they were satisfied with using Bakri balloon for PPH management in their index pregnancy.ConclusionsIntrauterine balloon tamponade for the management of severe PPH appeared to pose little adverse effects on subsequent menstrual and reproductive function.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-2085-6) contains supplementary material, which is available to authorized users.

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Prognostic factors for the use of intrauterine balloon tamponade in the management of severe postpartum hemorrhage

Abstract: The presence of adverse prognostic factors should prompt early resort to other treatment modalities or hysterectomy as a salvage procedure.

Cited by 31 publications

References 24 publications

<p>Obstetric Outcomes of Pregnancy After Uterine Artery Embolization</p>

<p>Obstetric Outcomes of Pregnancy After Uterine Artery Embolization</p>

Comparison of outcome between intrauterine balloon tamponade and uterine artery embolization in the management of persistent postpartum hemorrhage: A propensity score‐matched cohort study

Menstrual and reproductive outcomes after use of balloon tamponade for severe postpartum hemorrhage

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