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Intrauterine Balloon Tamponade for Severe Postpartum Hemorrhage
Mathilde Revert1, Patrick Rozenberg, Jonathan Cottenet
1EA 7285, Versailles Saint Quentin University, Versailles, the Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, Poissy, and Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, Bourgogne Franche-Comté University,Inserm, CIC 1432, and Dijon University Hospital, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon, and Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France.
Objective:
To compare the rates of invasive procedures (surgical or vascular) for hemorrhage control between a perinatal network that routinely used intrauterine balloon tamponade and another perinatal network that did not in postpartum hemorrhage management.
Methods:
This population-based retrospective cohort study included all women (72,529) delivering between 2011 and 2012 in the 19 maternity units in two French perinatal networks: a pilot (in which balloon tamponade was used) and a control network. Outcomes were assessed based on discharge abstract data from the national French medical information system. General and obstetric characteristics were included in two separate multivariate logistic models according to the mode of delivery (vaginal and cesarean) to estimate the independent association of the network with invasive procedures.
Results:
Invasive procedures (pelvic vessel ligation, arterial embolization, hysterectomy) were used in 298 women and in 4.1 per 1,000 deliveries (95% CI 3.7-4.6). The proportion of women with at least one invasive procedure was significantly lower in the pilot network (3.0/1,000 vs 5.1/1,000, P<.01). Among women who delivered vaginally, the use of arterial embolization was also significantly lower in the pilot than the control network (0.2/1,000 vs 3.7/1,000, P<.01) as it was for those who delivered by cesarean (1.3/1,000 vs 5.7/1,000, P<.01). After controlling for potential confounding factors, the risk of an invasive procedure among women who delivered vaginally remained significantly lower in the pilot network (adjusted odds ratio [OR] 0.14, 95% CI 0.08-0.27), but not for women who delivered by cesarean (adjusted OR 1.19, 95% CI 0.87-1.61).
Conclusion:
The use of intrauterine balloon tamponade in routine clinical practice was associated with a significantly lower use of invasive procedures for hemorrhage control among women undergoing vaginal delivery.
