When is the optimal time to remove uterine compression balloons? An 11-year retrospective cohort study

Intrauterine balloon tamponade is an appropriate first-line "surgical" intervention where uterine atony is the principal cause of hemorrhage. The optimal duration of insertion is unclear. Patients are often treated as "at risk" of bleeding while an intrauterine balloon is in situ. The present study aimed to ascertain if duration of intrauterine balloon use is associated with volume of blood loss at time of removal.

An 11-year data collection of all intrauterine balloons inserted at a tertiary hospital was conducted.

Intrauterine balloons were inserted for 279 patients over 137 months (2.0 month). Their mean body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) was 27.4 (±6.5, 16.3-57.8). The median parity was (2, 0-7), with an average estimated blood loss (EBL) of 2137 mL (±938 mL, 500-5620). The mean length of time intrauterine balloons were in situ was 16.3 h (±7.5, 0-51). The mean additional blood loss at removal was 92 mL ± 152.9. There was a positive correlation between EBL at delivery and the length of time the intrauterine balloon was left in situ (r = 2.67, P < 0.01). No difference was seen in additional blood loss at removal of those balloons left in situ for more than 12 h (98 mL ± 160) compared with less than 12 h (80 mL ± 136, P = 0.59). Continuous oxytocin infusions were used in all but 16 cases during balloon insertion. A total of 55 patients were fed with an intrauterine balloon in situ (19.6%, n = 280).

Intrauterine balloons are left in for longer than necessary, and earlier removal is not associated with a greater blood loss. We suggest that earlier removal is reasonable and should the balloon prove successful at insertion, patients should not be treated as at ongoing risk of bleeding. Further randomized studies should be conducted to elicit optimal time of removal to improve patient experience and flow through the labor ward.