The relationship between timing of postpartum hemorrhage interventions and adverse outcomes

Howard, Tera; Grobman, William A.

doi:10.1016/j.ajog.2015.04.017

Cited by 29 publications

(12 citation statements)

References 10 publications

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“…Consequently, there were proportionally more women with intrauterine balloon tamponade in the propensity score‐matched cohort who had more severe bleeding than there were in the total cohort of women who were initially managed by intrauterine balloon tamponade. 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 . 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: 97%

“…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%

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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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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

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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“…In addition, earlier use of balloon occlusion among women with postpartum hemorrhage was associated with fewer occurrences of maternal morbidity [15]. However interventions such as UAE for diagnosis of placenta adhesion would not be routinely performed before development of postpartum hemorrhage in women.…”

Section: Discussionmentioning

confidence: 99%

The efficacy of pre-delivery prophylactic trans-catheter arterial balloon occlusion of bilateral internal iliac artery in patients with suspected placental adhesion

Cho

Kim

et al. 2017

Obstet Gynecol Sci

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ObjectiveProphylactic trans-catheter arterial balloon occlusion (PTABO) before cesarean section of placenta previa totalis has been introduced to prevent massive hemorrhage. The purpose of this study is to evaluate the clinical usefulness of PTABO in cases of suspected placental adhesion and to examine antepartal risk factors and perinatal outcomes in women with placental adhesion.MethodsBetween January 2012 and December 2015, 77 patients who had undergone ultrasonography for evaluation of placenta previa were enrolled in this study. Seventeen of these patients with suspected placental adhesion by ultrasonography and Pelvic MRI underwent PTABO before cesarean section and another 59 patients underwent cesarean section without PTABO. Antepartal risk factors and peripartum maternal and neonatal outcomes were compared between patients with PTABO and those without PTABO.ResultsMore advanced maternal age, longer in gestational weeks at delivery, and more common previous cesarean section history were observed in the PTABO group. Placenta adhesion, abnormal Doppler findings, and frequency of transfusion were more common in the PTABO group. However there was no significant difference in estimated blood loss, hospital days, and neonatal outcome. It had occurred 3 cases of hysterectomy and 1 case of uterine artery embolization after cesarean section in the PTABO group.ConclusionClose surveillance of antepartum risk factors for placental adhesion using ultrasonography and pelvic magnetic resonance imaging is important to prevention of massive hemorrhage during cesarean section. PTABO before cesarean section might result in reduced blood loss and requirement for transfusion during the operation.

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“…Early employment of these interventions could minimize delay in hysterectomy in women in whom the bleeding proves refractory to these interventions. A study among 420 women with estimated blood loss > 500 mL after vaginal delivery and > 1000 mL after Cesarean delivery assessed the effect of timing of uterine balloon tamponade and uterine artery embolization on maternal morbidity, including hysterectomy and intensive care unit admission [55]. Timing of the intervention was expressed as a function of estimated blood loss at the moment of employment of the intervention, and early timing of balloon tamponade (n = 48) was associated with improved maternal outcomes.…”

Section: Improving Maternal Outcomes: Obstetric Interventions To Stopmentioning

confidence: 99%

Management of postpartum hemorrhage: how to improve maternal outcomes?

Henriquez

Bloemenkamp

Bom

2018

Journal of Thrombosis and Haemostasis

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Postpartum hemorrhage is the leading cause of maternal mortality and severe morbidity. Despite efforts to improve maternal outcomes, management of postpartum hemorrhage still faces at least four challenges, discussed in this review. First, current definitions for severe postpartum hemorrhage hamper early identification of women with a high risk of adverse outcomes. Adaptations to the definitions and the use of clinical tools such as shock index and early warning systems may facilitate this early identification. Second, surgical and radiological interventions to prevent hysterectomy are not always successful. More knowledge on the influence of patient and bleeding characteristics on the success rates of these interventions is necessary. Scarce data suggest that early timing of intrauterine balloon tamponade may improve maternal outcomes, whereas early timing of arterial embolization seems to be unrelated to maternal outcomes. Third, fluid resuscitation with crystalloids and colloids is unavoidable in the early phases of postpartum hemorrhage but may result in dilutional coagulopathy. Effects of different volumes of clear fluids on the occurrence of dilutional coagulopathy and maternal outcomes is unknown. Fourth, a better understanding of diagnosis and correction of coagulopathy during postpartum hemorrhage is needed. Low plasma fibrinogen levels at the start of postpartum hemorrhage predict progression to severe hemorrhage, but standard coagulation screens are time consuming. A solution may be point-of-care coagulation testing; however, clinical usefulness during postpartum hemorrhage has not been demonstrated. To date, early administration of tranexamic acid is the only hemostatic intervention that was proven to improve outcomes in women with postpartum hemorrhage.

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The relationship between timing of postpartum hemorrhage interventions and adverse outcomes

Cited by 29 publications

References 10 publications

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

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

The efficacy of pre-delivery prophylactic trans-catheter arterial balloon occlusion of bilateral internal iliac artery in patients with suspected placental adhesion

Management of postpartum hemorrhage: how to improve maternal outcomes?

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