Vacuum-induced tamponade for treatment of postpartum hemorrhage – smaller might well be better

Background Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and mortality worldwide. In the face of alarming data about rising maternal complications due to PPH, a trend mostly driven by an increase in uterine atony, we have to adopt new ways of thinking. We evaluated the efficacy of an innovative treatment modality for the treatment of PPH: a modified intrauterine balloon system with application of intrauterine vacuum.

Methods All women treated with vacuum-induced tamponade (VIT) using a modified balloon system were included in this single center observational study. Aiming to reduce uterine size for control of PPH, the intrauterine balloon was filled to only 50–100 mL and connected to a vacuum device. Success rate of VIT, defined as no need for additional interventional treatment, was analyzed for etiology of PPH (uterine atony or placental pathology) and experience acquired (observation periods A [2017–2018] or B [2019–2020]).

Results VIT was applied in 66 women. Median measured blood loss was overall 1500 mL (interquartile range [IQR] 1200–2400 mL), postpartum decrease in hemoglobin 44 g/L (IQR 31.3.–57.5 g/L) and transfusion of red blood cells was necessary in 11 women (17%). Overall success rate was 82%, with differences according to etiology of PPH and observation period: in women with uterine atony (n=44), success rate was 86% versus 73% in women with PPH due to placental pathology (n=22). Significant differences between observation periods were observed: success rate increased from 67% (A) to 94% (B) with a concomitant significant decrease in blood loss, postpartum decrease in hemoglobin, and transfusion rates. In observation period B, the VIT success rate in women with PPH due to uterine atony was 100% (n=22).

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Conclusions We experienced VIT as an easy-to-use and promising new technique for PPH treatment, above all in women with uterine atony and after obstetricians had developed confidence in the method. This observational study supports our pathophysiological understanding of uterine atony: to treat an atonic uterus, uterine volume must be reduced, leading to coiling of the uterine spiral arteries and hence reduced blood loss – smaller might well be better.

Publication History

Article published online:
26 November 2021