Efficacy of using controlled uterine balloon tamponade for stopping atonic postpartum hemorrhage

Abstract

BACKGROUND: Obstetric hemorrhage remains the leading cause of maternal mortality in Uzbekistan, with uterine atony in the follow-up and postpartum periods being the most common cause.

AIM: The aim of this study was to evaluate the effectiveness of using uterine balloon tamponade in atonic postpartum hemorrhage.

MATERIALS AND METHODS: This clinical controlled study was conducted at the Republican Perinatal Center of the Ministry of Health of the Republic of Uzbekistan from 2016 to 2019. Uterine balloon tamponade using a Zhukovsky balloon was used in 50 puerperas with atonic postpartum hemorrhage, of whom 40 women had vaginal delivery and ten patients were delivered by caesarean section. The control group consisted of 50 puerperas with atonic postpartum hemorrhage, traditional therapy being carried out without the use of uterine balloon tamponade, of whom 40 women had vaginal delivery and ten patients were delivered by caesarean section.

RESULTS: The total volume of blood loss in the main group was lower than in the control group: 998 ± 142 ml vs. 1498 ± 202 ml in vaginal delivery (Student’s t-test 2.01, p = 0.047563) and 1297 ± 244 ml vs. 1988 ± 226 ml at caesarean section (Student’s t-test 2.11, p = 0.039463), respectively. Uterine balloon tamponade allowed for stopping postpartum hemorrhage in the blood loss range of 750–999 ml and 1000–1499 ml in 27.5% and 52.5% of cases in the main group and in 20% and 30% of cases in the control group (OR 1.517, 95 % CI 1.536–4.293 and OR 2.579, 95% CI 1.030–6.457, respectively). When using uterine balloon tamponade, the proportion of massive bleeding with blood loss over 1500 ml was 3.8 times lower than in the control group: 10.0% (5/50) and 38% (19/50), respectively. Hysterectomy due to bleeding was performed in one (2%) postpartum woman in the main group, and in five (10%) puerperas in the control group (OR 0.184, 95% CI 1.021–6.133). The use of the tamponade test resulted in a significant decrease in the number of severe bleeding incidents (with blood loss of 1500 ml or more) by 90% during vaginal delivery (OR 0.077, 95% CI 0.009–0.635) and elevated the effectiveness of organ-preserving surgeries by 2.9 times, thus increasing the frequency of women with preserved uterus.

CONCLUSIONS: The effectiveness of uterine balloon tamponade in atonic postpartum hemorrhage was 88.0% (44/50). The simplicity and safety of using uterine balloon tamponade indicates the need for a wider introduction of this technology in postpartum hemorrhages, which will help to reduce their adverse outcomes.

Keywords

postpartum hemorrhage / uterine balloon tamponade / uterine atony / tamponade test

References

[1] World Health Organization [Internet]. Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division: executive summary. 2019. [cited 23 Aug 2021]. Available from: https://apps.who.int/iris/handle/10665/327596

[2] World Health Organization [Internet]. Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division: executive summary. 2019. [дата обращения 23.09.2021]. Доступ по ссылке: https://apps.who.int/iris/handle/10665/327596

[3] Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6):e323−e333. DOI: 10.1016/S2214-109X(14)70227-X

[4] Say L., Chou D., Gemmill A. et al. Global causes of maternal death: a WHO systematic analysis // Lancet. Glob. Health. 2014. Vol. 2. No. 6. P. e323−e333. DOI: 10.1016/S2214-109X(14)70227-X

[5] Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, et al. Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9947):980−1004. DOI: 10.1016/S0140-6736(14)60696-6

[6] Kassebaum N.J., Bertozzi-Villa A., Coggeshall M.S. et al. Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 // Lancet. 2014. Vol. 384 (9947). P. 980−1004. DOI: 10.1016/S0140-6736(14)60696-6

[7] Hogan MC, Foreman KJ, Naghavi M, et al. Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet. 2010;375(9726):1609−1623. DOI: 10.1016/S0140-6736(10)60518-1

[8] Hogan M.C., Foreman K.J., Naghavi M. et al. Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5 // Lancet. 2010. Vol. 375 (9726). P. 1609−1623. DOI: 10.1016/S0140-6736(10)60518-1

[9] Gupta M, Mitesh J. Role of condom catheter balloon tamponade in management of atonic postpartum haemorrhage in cases of failed medical management. Int J Clin Obstet Gynaecol. 2017;1(2):62−64.

[10] Gupta M., Mitesh J. Role of condom catheter balloon tamponade in management of atonic postpartum haemorrhage in cases of failed medical management // Int. J. Clin. Obstet. Gynaecol. 2017. Vol. 1. No. 2. P. 62−64.

[11] Sharma A, Bansal N, Ramola M, et al. Bakri postpartum balloon: an obstetrician’s armamentarium in managing post-partum haemorrhage. Int J Reprod Contracept Obstet Gynecol. 2020;9(5):2113−2117. DOI: 10.18203/2320-1770.ijrcog20201814

[12] Sharma A., Bansal N., Ramola M. et al. Bakri postpartum balloon: an obstetrician’s armamentarium in managing post-partum haemorrhage // Int. J. Reprod. Contracept. Obstet. Gynecol. 2020. Vol. 9. No. 5. P. 2113−2117. DOI: 10.18203/2320-1770.ijrcog20201814

[13] In the name of saving the lives of mothers. The Third Report of the Confidential Enquiries into Maternal Deaths (2016–2017). Tashkent; 2020: 112. [cited 23 Aug 2021]. Available from: https://uzbekistan.unfpa.org/sites/default/files/pub-pdf/kisms_3-y_nac_otchet_2016-2017.pdf

[14] Во имя спасения жизни матерей. Третий отчет по конфиденциальному исследованию случаев материнской смертности (за 2016–2017 гг.). Ташкент, 2020. [дата обращения 23.08.2021]. Доступ по ссылке: https://uzbekistan.unfpa.org/sites/default/files/pub-pdf/kisms_3-y_nac_otchet_2016-2017.pdf

[15] Frenzel D, Condous GS, Papageorghiou AT, McWhinney NA. The use of the “tamponade test” to stop massive obstetric haemorrhage in placenta accrete. BJOG. 2005;112(5):676−677. DOI: 10.1111/j.1471-0528.2005.00491.x

[16] Frenzel D., Condous G.S., Papageorghiou A.T., McWhinney N.A. The use of the “tamponade test” to stop massive obstetric haemorrhage in placenta accrete // BJOG. 2005. Vol. 112. No. 5. P. 676−677. DOI: 10.1111/j.1471-0528.2005.00491.x

[17] Condous GS, Arulkumaran S, Symonds I, et al. The “tamponade test” in the management of massive postpartum hemorrhage. Obstet Gynecol. 2003;101(4):767−772. DOI: 10.1016/s0029-7844(03)00046-2

[18] Condous G.S., Arulkumaran S., Symonds I. et al. The “tamponade test” in the management of massive postpartum hemorrhage // Obstet. Gynecol. 2003. Vol. 101. No. 4. P. 767−772. DOI: 10.1016/s0029-7844(03)00046-2

[19] Suarez S, Conde-Agudelo A, Borovac-Pinheiro A, et al. Uterine balloon tamponade for the treatment of postpartum hemorrhage: a systematic review and meta-analysis. Am J Obstet Gynecol. 2020;222(4):293.e1−293.e52. DOI: 10.1016/j.ajog.2019.11.1287

[20] Suarez S., Conde-Agudelo A., Borovac-Pinheiro A. et al. Uterine balloon tamponade for the treatment of postpartum hemorrhage: a systematic review and meta-analysis // Am. J. Obstet. Gynecol. 2020. Vol. 222. No. 4. P. 293.e1−293.e52. DOI: 10.1016/j.ajog.2019.11.1287

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