Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Oct;128(11):1732-1743.
doi: 10.1111/1471-0528.16819. Epub 2021 Jul 19.

Effectiveness of uterine tamponade devices for refractory postpartum haemorrhage after vaginal birth: a systematic review

V Pingray  1 , M Widmer  2 , A Ciapponi  1 , G J Hofmeyr  3   4 , C Deneux  5 , M Gülmezoglu  2   6 , K Bloemenkamp  7 , O T Oladapo  2 , D Comandé  1 , A Bardach  1 , P Vázquez  1 , G Cormick  1 , F Althabe  2
Affiliations

Effectiveness of uterine tamponade devices for refractory postpartum haemorrhage after vaginal birth: a systematic review

V Pingray et al. BJOG. 2021 Oct.

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 (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.

Keywords: Bakri balloon; condom uterine balloon tamponade; hysterectomy; maternal death; postpartum haemorrhage; uterine atony; vaginal delivery.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Quality assessment of included studies.
See this image and copyright information in PMC

Comment in

References

    1. Say L, Chou D, Gemmill A, Tuncalp O, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2014;2:e323–33. - PubMed
    1. World Health Organization . WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage. Geneva, Switzerland: World Health Organization; 2012. - PubMed
    1. Widmer M, Piaggio G, Hofmeyr GJ, Carroli G, Coomarasamy A, Gallos I, et al. Maternal characteristics and causes associated with refractory postpartum haemorrhage after vaginal birth: a secondary analysis of the WHO CHAMPION trial data. BJOG 2020;127:628–34. - PMC - PubMed
    1. Widmer M, Piaggio G, Nguyen TMH, Osoti A, Owa OO, Misra S, et al. Heat‐stable carbetocin versus oxytocin to prevent hemorrhage after vaginal birth. N Engl J Med 2018;379:743–52. - PubMed
    1. Mousa HA, Cording V, Alfirevic Z. Risk factors and interventions associated with major primary postpartum hemorrhage unresponsive to first‐line conventional therapy. Acta Obstet Gynecol Scand 2008;87:652–61. - PubMed

Publication types

MeSH terms