Effectiveness of uterine tamponade devices for refractory postpartum haemorrhage after vaginal birth: a systematic review
Pingray, V.; Widmer, M.; Ciapponi, A.; Hofmeyr, G. J.; Deneux, C.; Gülmezoglu, M.; Bloemenkamp, K.; Oladapo, O. T.; Comandé, D.; Bardach, A.; Vázquez, P.; Cormick, G.; Althabe, F.
(2021) BJOG: An International Journal of Obstetrics and Gynaecology, volume 128, issue 11, pp. 1732 - 1743
(Article)
Abstract
Objectives: To evaluate uterine tamponade devices’ effectiveness for atonic refractory postpartum haemorrhage (PPH) after vaginal birth and the effect of including them in institutional protocols. Search strategy: PubMed, EMBASE, CINAHL, LILACS, POPLINE, from inception to January 2021. Study selection: Randomised and non-randomised comparative studies. Outcomes: Composite outcome including surgical interventions
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(artery ligations, compressive sutures or hysterectomy) or maternal death, and hysterectomy. Results: All included studies were at high risk of bias. The certainty of the evidence was rated as very low to low. One randomised study measured the effect of the condom-catheter balloon compared with standard care and found unclear results for the composite outcome (relative risk [RR] 2.33, 95% CI 0.76–7.14) and hysterectomy (RR 4.14, 95% CI 0.48–35.93). Three comparative studies assessed the effect of including uterine balloon tamponade in institutional protocols. A stepped wedge cluster randomised controlled trial suggested an increase in the composite outcome (RR 4.08, 95% CI 1.07–15.58) and unclear results for hysterectomy (RR 4.38, 95% CI 0.47–41.09) with the use of the condom-catheter or surgical glove balloon. One non-randomised study showed unclear effects on the composite outcome (RR 0.33, 95% CI 0.11–1.03) and hysterectomy (RR 0.49, 95% CI 0.04–5.38) after the inclusion of the Bakri balloon. The second non-randomised study found unclear effects on the composite outcome (RR 0.95, 95% CI 0.32–2.81) and hysterectomy (RR 1.84, 95% CI 0.44–7.69) after the inclusion of Ebb or Bakri balloon. Conclusions: The effect of uterine tamponade devices for the management of atonic refractory PPH after vaginal delivery is unclear, as is the role of the type of device and the setting. Tweetable abstract: Unclear effects of uterine tamponade devices and their inclusion in institutional protocols for atonic refractory PPH after vaginal delivery.
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Keywords: Bakri balloon, condom uterine balloon tamponade, hysterectomy, maternal death, postpartum haemorrhage, uterine atony, vaginal delivery, Maternal Mortality, Postpartum Hemorrhage/mortality, Humans, Vagina, Ligation/instrumentation, Treatment Outcome, Hysterectomy/mortality, Uterine Artery Embolization/instrumentation, Uterine Balloon Tamponade/instrumentation, Pregnancy, Delivery, Obstetric/adverse effects, Uterine Artery/surgery, Hemostatic Techniques/instrumentation, Adult, Female, Obstetrics and Gynaecology, Journal Article
ISSN: 1470-0328
Publisher: Wiley-Blackwell
Note: Funding Information: Funding was provided by UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, WHO. We thank Thomas Allen for developing the search strategy and Ayodele Lewis and Caitlin R. Williams for editing the manuscript. Publisher Copyright: © 2021 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.
(Peer reviewed)