158: Predictors of failed intrauterine balloon tamponade for persistent primary postpartum hemorrhage after vaginal delivery

Abstract

To determine predictors of failed intrauterine balloon tamponade (IUBT) for persistent primary postpartum hemorrhage (PPH) after vaginal delivery. This was a retrospective survey in five hospitals in a French perinatal network. All women who underwent IUBT for persistent PPH after vaginal delivery in these hospitals from 2011-2015 were included. All maternity belong to the same perinatal network and apply the same management policy for PPH. IUBT, using a Bakri balloon (Cook Medical, Bloomington, IN, USA), was used as a second line therapy for persistent PPH after failure of uterine massage and uterotonic agents to stop bleeding. Women were identified in the hospital discharge database. Women in the case group were defined as women who had IUBT but required another second line therapy (embolization or surgical procedures) to stop bleeding, and women whom IUBT stopped bleeding were defined as control group. Univariate and logistic regression analyses were performed to determine independent predictors for failed IUBT. The study was approved by the French Ethics Review Committee (No. CEROG OBS 2016-03-28) and we obtained informed consent from the women. During the study period, there were 91,880 deliveries in the 5 hospitals, and 1,367 persistent PPH after vaginal delivery (1.5%) were registered. IUBT was used in 108 women (7.9%) to control PPH. Bleeding stopped after IUBT in 80 women (74.1%). In 28 women, invasive procedures were required, including 19 embolization and 9 surgical procedures with 5 peripartum hysterectomies. Women with failed IUBT were more often obese (BMI ≥ 30 kg/m2) (25.9% vs. 8.1%; P=.03), duration of labor was shorter (363.9 min vs. 549.7min, P=.04), and severe PPH (blood loss>1,500 mL) before IUBT was more frequent (64% vs. 40%; P=.04). In the multivariable logistic regression analysis (adjusted for maternal age, BMI before pregnancy, and blood loss), maternal obesity was a predictive factor of failed IUBT (aOR 4.40, CI95% 1.06-18.31). Severe PPH before IUBT seemed to be another predictor of failure (aOR 1.001, CI95% 1.000-1.002; P=.055), but our result did not reach statistical significativity. Intrauterine balloon tamponade is an effective second line therapy for persistent PPH after vaginal delivery. Maternal obesity and delayed use of the device are the main risk factors of failure.