Mechanical and surgical interventions for treating primary postpartum haemorrhage

Area of Science:

• Obstetrics and Gynecology
• Maternal Health
• Surgical Interventions

Background:

• Primary postpartum hemorrhage (PPH) is a major cause of maternal mortality worldwide.
• Mechanical and surgical interventions are used to manage PPH.
• This review focuses on the effectiveness and safety of these interventions.

Purpose of the Study:

• To evaluate the effectiveness and safety of mechanical and surgical interventions for primary PPH.
• To synthesize evidence from randomized controlled trials (RCTs) comparing these interventions with standard care or other methods.

Main Methods:

• Searched multiple databases including Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, and ICTRP.
• Included RCTs of mechanical/surgical methods for PPH management (e.g., uterine packing, balloon insertion, artery ligation/embolism, uterine compression).
• Two authors independently assessed study inclusion, risk of bias, and data extraction, using GRADE for evidence certainty.

Main Results:

• Nine small trials (944 women) were included, generally at unclear risk of bias.
• Due to heterogeneity, meta-analysis was not possible; most outcomes had very low to low certainty evidence.
• Specific interventions like external uterine compression, uterine artery embolisation, and various intrauterine tamponade methods showed unclear effects on outcomes such as blood transfusion, hysterectomy, and mortality.

Conclusions:

• Insufficient RCT evidence exists to determine the effectiveness and safety of mechanical/surgical PPH interventions.
• High-quality RCTs are urgently needed, with standardized core outcomes for consistency.
• Current evidence does not support the standalone introduction of certain interventions like condom-balloon tamponade in low-resource settings without quality improvement.