162: Evaluation of the efficacy of the intrauterine balloon tamponade as a second-line procedure in the management of severe postpartum hemorrhage within a perinatal network

Abstract

tamponade as a second-line procedure in the management of severe postpartum hemorrhage within a perinatal network Thomas Popowski, Pierre Raynal, Patrick Rozenberg Poissy Saint-Germain Hospital, Versailles Saint-Quentin-en-Yvelines University, research unit EA 7285, Department of Obstetrics and Gynecology, Poissy, France, Mignot Hospital, Department of Obstetrics and Gynecology, Le Chesnay, France OBJECTIVE: To evaluate the efficacy of the intrauterine balloon tamponade (IUBT) as the initial second-line procedure when medical management fails in the management of severe postpartum hemorrhage (PPH). STUDY DESIGN: We carried out a prospective cohort study within a perinatal network comprising 10 perinatal units managing around 20,000 deliveries per annum. The protocol for management of PPH followed the French national guidelines. In April 2008, the IUBT using Bakri balloon was introduce in the tertiary referral university hospital and the protocol was modified to require that an IUBT test be used before any invasive procedure in PPH unresponsive to prostaglandin. The modified protocol was progressively extended to the 9 other maternities. The tamponade test was considered successful if control was achieved following inflation of the balloon. RESULTS: Between April 2008 and June 2012, 166 IUBT tests were performed. The mean maternal age was 30.4 (SD 5.2) years, the mean gestational age 39.1 (SD 2.5) WG, and the mean parity 1.1 (SD 1.2). Nineteen (11.5%) patients had a previous history of cesarean section (CS), 25 (15.1%) a previous history of PPH, 14 (8.4%) were multiple pregnancies, and 8 (4.8%) presented a placenta previa. Among the 166 patients, the mean blood loss was 1484 (SD 602) mL, 105 (63.3%) patients had blood transfusion with a mean of 3.9 (SD 2.8) units of packed red blood cells. Among the 122 patients delivered vaginally, the IUBT failed in 17 (13.9%) patients leading to 11 embolizations, 2 conservative surgical procedures, and 4 hysterectomies. Among the 44 patients delivered by CS, the IUBT failed in 10 (22.7%) patients leading to 5 embolizations, 3 conservative surgical procedures, and 2 hysterectomies. The global success rate of the IUBT was 83.7%. CONCLUSION: In the setting of PPH unresponsive to medical management, IUBT should be used as the initial second-line procedure.