Prognostic factors for the use of intrauterine balloon tamponade in the management of severe postpartum hemorrhage

Abstract

Objective: To identify prognostic factors associated with successful management of severe postpartum hemorrhage (PPH) using intrauterine balloon tamponade (IUBT).

Methods: Retrospective review of all cases of severe PPH with blood loss greater than 1 L in a tertiary unit in Hong Kong from July 1, 2012, to June 30, 2017. Records of patients who had undergone IUBT insertion were reviewed. Univariate analysis and logistic regression models were used to identify prognostic factors for successful management with IUBT.

Results: Of 22 860 deliveries during the study period, severe PPH occurred in 1.4% (n=311), and IUBT was attempted in 26.0% (n=81) of these patients. IUBT alone was successful in arresting hemorrhage in 72.8% (n=59), and the overall rate for avoiding hysterectomy was 86.4% (n=70). Presence of coagulopathy (P=0.048) and placenta accreta (P=0.048) were the adverse prognostic factors associated with higher failure rates. Less blood loss (≤1400 mL) at the time of insertion of IUBT and a positive tamponade test (≤50 mL of blood drained from the uterus within the first 30 minutes after insertion of IUBT) were good predictors for success of IUBT.

Conclusion: The presence of adverse prognostic factors should prompt early resort to other treatment modalities or hysterectomy as a salvage procedure.

Keywords: Bakri balloon; Balloon tamponade; Postpartum hemorrhage; Prediction; Prognostic factor; Uterine balloon.