Uterine balloon tamponade for postpartum hemorrhage is effective and low risk

  • Am J Obstet Gynecol

  • Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • Uterine balloon tamponade (UBT) for the treatment of postpartum hemorrhage (PPH) is generally successful and associated with low risk for complications.

Why this matters

  • PPH is the leading cause of maternal morbidity and mortality worldwide.

Key results

  • The overall pooled rate of UBT success (90 studies) was 85.9% (95% CI, 83.9%-87.9%).
  • UBT was most successful for (95% CIs): 
    • Uterine atony: 87.1% (84.1%-89.9%); and
    • Placenta previa: 86.8% (82.3%-90.6%).
  • UBT was least successful for:
    • Placenta accreta spectrum disorder: 66.7% (49.4%-81.9%); and
    • Retained products of conception: 76.8% (65.3%-86.5%).
  • UBT was more successful in cases of vaginal delivery compared with cesarean delivery: 87.1% vs 81.7%.
  • Overall complication rate was ≤6.5%.
  • Complications of UBT included fever or infection (6.5%), endometritis (2.3%), cervical tears (1.7%), laceration of lower segment of vagina (4.8%), uterine incision rupture (1.9%), and uterine perforation (2.0%).
  • UBT reduced the use of arterial embolization: relative risk, 0.29 (95% CI, 0.14-0.63).

Study design 

  • Systematic review and meta-analysis (91 studies; 4729 women).
  • The main outcome measure was the success rate of UBT for the treatment of all causes of PPH.
  • Funding: None.

Limitations

  • Limitations related to limitations of original studies.