Predictors of Failed Intrauterine Balloon Tamponade in the Management of Severe Postpartum Hemorrhage.

Congcong Liu,Jingxia Sun,Shixiu Liao,Jinsong Gao,Jing He,Juntao Liu,Xiaowei Liu,Xietong Wang

doi:10.3389/fmed.2021.656422

Abstract

To identify the factors predicting intrauterine balloon tamponade (IUBT) failure for severe postpartum hemorrhage (PPH) after delivery, we conducted a retrospective cohort study of women who underwent IUBT for severe PPH after delivery from October 1, 2016 until September 30, 2017. The failure of IUBT was defined as the need of additional surgical procedures or uterine embolization. A total of 99,650 deliveries occurred during the study period. Among the patients, 106 cases of severe PPH were managed with IUBT, and the global success rate was 70.8% (75/106). Least absolute shrinkage and selection operator (LASSO) regression was performed to select the potential risk factors predicting IUBT failure. The associated risk factors—obesity, multiple gestation, cesarean delivery, estimated blood loss (EBL), and placenta accreta spectrum (PAS)—were included in multivariate logistic models. Ultimately, these models identified multiple gestation, EBL, and PAS as independent risk factors for IUBT failure. In conclusion, IUBT is an effective method for severe PPH. The presence of factors affecting IUBT failure should be recognized early, and other modalities of management should be anticipated.

Highlights

Postpartum hemorrhage (PPH) is still a major cause of maternal mortality worldwide [1]
106 cases of severe postpartum hemorrhage (PPH) were managed with intrauterine balloon tamponade (IUBT), 20 (18.9%) after vaginal delivery and 86 (81.1%) during or after cesarean section
The results showed that obesity, multiple gestation, cesarean delivery, estimated blood loss (EBL), and placenta accreta spectrum (PAS) had predictive significance for IUBT failure (Figure 2)

Summary

Introduction

Postpartum hemorrhage (PPH) is still a major cause of maternal mortality worldwide [1]. The universal two-child policy in China has been associated with a higher proportion of elderly pregnant women, and the incidence of PPH has significantly increased [2]. It is a great challenge to actively prevent and treat PPH and reduce maternal morbidity and mortality. Severe PPH is defined as a blood loss of ≥1,000 ml within 24 h after delivery [3]. If patients with severe PPH are unresponsiveness to uterine massage and first-line uterotonic agents, further invasive procedures may be required. Conservative surgical procedures include intrauterine balloon tamponade (IUBT), uterine compression sutures, pelvic vessel ligation, and arterial

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