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Am J Perinatol 2017; 34(02): 164-168
DOI: 10.1055/s-0036-1585084
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Is There an Association Between Indication for Intrauterine Balloon Tamponade and Balloon Failure?

Moeun Son
1   Division of Maternal-Fetal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
,
Brett D. Einerson
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
,
Patrick Schneider
3   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Chicago School of Medicine, Chicago, Illinois
,
Ian C. Fields
4   Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
,
William A. Grobman
1   Division of Maternal-Fetal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
,
Emily S. Miller
1   Division of Maternal-Fetal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
› Author Affiliations
Further Information

Publication History

19 April 2016

01 June 2016

Publication Date:
01 July 2016 (online)

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Abstract

Objective Determine whether the indication for intrauterine balloon tamponade (IUBT) is associated with failure rates.

Study Design Cohort study of women who underwent IUBT for postpartum hemorrhage (PPH) from 2007 to 2014. The indication was categorized as uterine atony or placental-site bleeding. Primary outcome was IUBT failure, defined as the need for uterine artery embolization or hysterectomy. Secondary outcomes were estimated blood loss (EBL) after balloon placement, transfusion of red blood cells (RBC), transfusion of fresh frozen plasma (FFP) and/or cryoprecipitate, and intensive care unit (ICU) admission.

Results 306 women underwent IUBT: 241 (78.8%) for uterine atony and 65 (21.2%) for placental site bleeding. Overall, 67 (21.9%) women experienced IUBT failure. The frequency of failure was similar in those with uterine atony compared with those with placental-site bleeding (21.2 vs 24.6%, p = 0.55). This finding persisted after adjusting for potential confounders (aOR, 0.97; 95% CI, 0.48–1.99). Median EBL after balloon placement (190 [interquartile range, 93–375] vs 195 [interquartile range, 103–500] mL, p = 0.46), and frequencies of RBC transfusion (62.7 vs 66.2%, p = 0.60), FFP and/or cryoprecipitate transfusion (25.3 vs 33.8%, p = 0.17), and ICU admission (12.4 vs 16.9%, p = 0.35) were also similar.

Conclusion IUBT was similarly effective for managing PPH from uterine atony or placental-site bleeding.

Keywords

postpartum hemorrhage - intrauterine balloon tamponade - uterine atony - placental site bleeding

Note

This study was presented at the 36th annual meeting of the Society for Maternal–Fetal Medicine, Atlanta, GA, February 1 to 6, 2016.


 

  • References

  • 1 Lalonde A, Daviss BA, Acosta A, Herschderfer K. Postpartum hemorrhage today: ICM/FIGO initiative 2004-2006. Int J Gynaecol Obstet 2006; 94 (3) 243-253
    CrossrefPubMedGoogle Scholar
  • 2 Haeri S, Dildy III GA. Maternal mortality from hemorrhage. Semin Perinatol 2012; 36 (1) 48-55
    CrossrefPubMedGoogle Scholar
  • 3 Shields LE, Smalarz K, Reffigee L, Mugg S, Burdumy TJ, Propst M. Comprehensive maternal hemorrhage protocols improve patient safety and reduce utilization of blood products. Am J Obstet Gynecol 2011; 205 (4) 368.e1-368.e8
    CrossrefPubMedGoogle Scholar
  • 4 Bakri YN. Uterine tamponade-drain for hemorrhage secondary to placenta previa-accreta. Int J Gynaecol Obstet 1992; 37 (4) 302-303
    CrossrefPubMedGoogle Scholar
  • 5 Bakri YN, Amri A, Abdul Jabbar F. Tamponade-balloon for obstetrical bleeding. Int J Gynaecol Obstet 2001; 74 (2) 139-142
    CrossrefPubMedGoogle Scholar
  • 6 Yorifuji T, Tanaka T, Makino S, Koshiishi T, Sugimura M, Takeda S. Balloon tamponade in atonic bleeding induces uterine contraction: attempt to quantify uterine stiffness using acoustic radiation force impulse elastography before and after balloon tamponade. Acta Obstet Gynecol Scand 2011; 90 (10) 1171-1172
    CrossrefPubMedGoogle Scholar
  • 7 Dabelea V, Schultze PM, McDuffie Jr RS. Intrauterine balloon tamponade in the management of postpartum hemorrhage. Am J Perinatol 2007; 24 (6) 359-364
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Aibar L, Aguilar MT, Puertas A, Valverde M. Bakri balloon for the management of postpartum hemorrhage. Acta Obstet Gynecol Scand 2013; 92 (4) 465-467
    CrossrefPubMedGoogle Scholar
  • 9 Doumouchtsis SK, Papageorghiou AT, Vernier C, Arulkumaran S. Management of postpartum hemorrhage by uterine balloon tamponade: prospective evaluation of effectiveness. Acta Obstet Gynecol Scand 2008; 87 (8) 849-855
    CrossrefPubMedGoogle Scholar
  • 10 Vitthala S, Tsoumpou I, Anjum ZK, Aziz NA. Use of Bakri balloon in post-partum haemorrhage: a series of 15 cases. Aust N Z J Obstet Gynaecol 2009; 49 (2) 191-194
    CrossrefPubMedGoogle Scholar
  • 11 Grönvall M, Tikkanen M, Tallberg E, Paavonen J, Stefanovic V. Use of Bakri balloon tamponade in the treatment of postpartum hemorrhage: a series of 50 cases from a tertiary teaching hospital. Acta Obstet Gynecol Scand 2013; 92 (4) 433-438
    CrossrefPubMedGoogle Scholar
  • 12 Dildy GA, Belfort MA, Adair CD , et al; ebb Surveillance Study Team. Initial experience with a dual-balloon catheter for the management of postpartum hemorrhage. Am J Obstet Gynecol 2014; 210 (2) 136.e1-136.e6
    CrossrefPubMedGoogle Scholar
  • 13 Laas E, Bui C, Popowski T, Mbaku OM, Rozenberg P. Trends in the rate of invasive procedures after the addition of the intrauterine tamponade test to a protocol for management of severe postpartum hemorrhage. Am J Obstet Gynecol 2012; 207 (4) 281.e1-281.e7
    CrossrefPubMedGoogle Scholar
  • 14 Einerson BD, Miller ES, Grobman WA. Does a postpartum hemorrhage patient safety program result in sustained changes in management and outcomes?. Am J Obstet Gynecol 2015; 212 (2) 140-4.e1
    CrossrefPubMedGoogle Scholar