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Xu TY, Fu Q. Risk factors for Bakri balloon tamponade failure in the management of postpartum hemorrhage. Int J Gynaecol Obstet 2023; 160:685-690. [PMID: 35841386 DOI: 10.1002/ijgo.14349] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/25/2022] [Accepted: 07/07/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To predict risk factors for Bakri balloon tamponade (BBT) failure in the management of postpartum hemorrhage (PPH). METHODS The data of 599 patients who underwent BBT were retrospectively analyzed from January 1, 2017 to December 31, 2021 in a tertiary hospital in Shanghai, East China. The patients were divided into the failure group and the success group. Failure was defined as the inability to control bleeding, which required surgical interventions. Maternal characteristics, PPH characteristics, PPH management approaches, and maternal complications were compared between the groups. The independent predictors of BBT failure were analyzed by logistic regression analysis. RESULTS The overall success rate of BBT was 83.0% (497/599). The blood loss before and after balloon insertion in the failure group was significantly greater than that in the success group. Of the 102 failures, B-Lynch suture was performed in one patient, uterine artery embolization was performed in 99 patients (with one failure), and total hysterectomy was performed in three patients. Some risk factors, including twin gestation (odds ratio [OR] 9.68), placenta accreta spectrum with/without placenta previa (OR 4.45), estimated blood loss at least 1135 ml at balloon insertion (OR 3.35), multiparous (OR 2.72), and in vitro fertilization-embryo transfer (OR 2.00) were strongly associated with BBT failure. CONCLUSION BBT seemed to be a less effective tool in the management of PPH due to placenta accreta spectrum with/without placenta previa and twin gestation.
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Affiliation(s)
- Tian-Yi Xu
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 20030, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 20030, China
| | - Qin Fu
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 20030, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 20030, China
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Risk Factors for Intrauterine Tamponade Failure in Postpartum Hemorrhage. Obstet Gynecol 2022; 140:439-446. [PMID: 35926196 DOI: 10.1097/aog.0000000000004888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/26/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To identify factors associated with intrauterine tamponade failure after vaginal or cesarean delivery. METHODS This was a nationwide population-based cohort study that used data from the French Programme de Médicalisation des Systèmes d'Information. This study compared the failure and effectiveness of intrauterine tamponade among all women who received the procedure in France from January 1, 2019, to December 31, 2019. Failure was defined as the use of a second-line method (uterine artery embolization, conservative or radical surgery, or death) within 7 days of intrauterine tamponade. Factors associated with intrauterine tamponade failure were identified by univariate analyses and tested using multivariate generalized logistic regression models (with a random intercept on institution) to obtain adjusted odds ratio (aOR) and 95% CI statistics. RESULTS A total of 39,193 patients presented with postpartum hemorrhage in 474 French maternity wards. Of these patients, 1,761 (4.5%) received intrauterine tamponade for persistent bleeding. The effectiveness rate of intrauterine tamponade was 88.9%. For 195 women (11.1%), a second-line method was indicated. Patients for whom intrauterine tamponade failed had a higher maternal age, a lower mean gestational age, and more frequent instances of placental abnormalities, preeclampsia, cesarean birth, and uterine rupture. The multivariate analysis revealed that cesarean birth (aOR 4.2; 95% CI 2.9-6.0), preeclampsia (aOR 2.3; 95% CI 1.3-4.0), and uterine rupture (aOR 14.1; 95% CI 2.4-83.0) were independently associated with intrauterine tamponade failure. CONCLUSION Cesarean delivery, preeclampsia, and uterine rupture are associated with intrauterine tamponade failure in the management of postpartum hemorrhage.
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Puente-Luján MJ, Andrés-Orós MP, Álvarez-Sarrado L, Agustín-Oliva A, González-Ballano I, Rodríguez-Solanilla B, Castán-Mateo S. Bakri Balloon: an easy, useful and effective option for the treatment of postpartum haemorrhage. J OBSTET GYNAECOL 2022; 42:1788-1792. [PMID: 35291903 DOI: 10.1080/01443615.2022.2039903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We report our postpartum haemorrhage protocol focussing on the use of Bakri Balloon, describing its placement and affixing method, effectiveness rates, risk factors that might contribute to Bakri Balloon's failure and complications associated. We designed a retrospective study including 147 cases where a Bakri Balloon was necessary to control the postpartum uterine bleeding to assess the efficacy and to determine which clinical, obstetric or delivery variables could be associated with successful treatment. Failed treatment was defined when surgery or any other technique was needed after a Bakri Balloon placement in order to control uterine bleeding. For statistical analysis, we developed a descriptive analysis and a univariate logistic regression study.IMPACT STATEMENTWhat is already known on this subject? Postpartum haemorrhage is one of the most severe situations in the immediate postpartum period entailing a major cause of maternal morbimortality if an accurate and quick intervention is not carried out.What do the results of this study add? The use of Bakri Balloon was effective in 94.6% of patients. No statistically significant differences were found in the success rates according to obstetric or delivery characteristics. No major complications occurred due to the placement of a Bakri Balloon. In the failure group, blood loss was significantly higher and all required blood products transfusion.What are the implications of these findings for clinical practice and/or further research? Bakri Balloon is an easy-to-use device that provides an effective therapeutic alternative to more aggressive techniques in postpartum haemorrhages when medical treatment fails. Obstetrics or delivery characteristics should not entail a contraindication in its use. A continuous training system based on an agreed protocol is recommended in order to guarantee the best care possible.
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Affiliation(s)
| | | | | | - Andrea Agustín-Oliva
- Department of Obstetrics, Miguel Servet Maternal University Hospital, Zaragoza, Spain
| | | | | | - Sergio Castán-Mateo
- Department of Obstetrics, Miguel Servet Maternal University Hospital, Zaragoza, Spain
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Affiliation(s)
- Jessica L Bienstock
- From the Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore
| | - Ahizechukwu C Eke
- From the Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore
| | - Nancy A Hueppchen
- From the Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore
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Leleu A, Ghesquiere L, Machuron F, Caudrelier C, Devouge P, Subtil D, Houflin-Debarge V, Garabedian C. Intrauterine balloon tamponade in the management of severe postpartum haemorrhage after vaginal delivery: Is the failure early predictable? Eur J Obstet Gynecol Reprod Biol 2021; 258:317-323. [PMID: 33498006 DOI: 10.1016/j.ejogrb.2021.01.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/10/2021] [Accepted: 01/18/2021] [Indexed: 11/30/2022]
Abstract
Postpartum haemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality world-wide. The arrival of intrauterine balloon devices has revolutionised PPH management. However, it seems interesting to know the situations of failure to improve the management. The objective is to define the factors related to failure of intrauterine balloon tamponade (IUBT) in women with a postpartum haemorrhage (PPH) after vaginal delivery, and especially blood loss after placement to avoid delaying management. Retrospective cohort study was conducted in 2 centers. All PPH after vaginal deliveries treated by IUBT were included. Two groups were defined (successes and failures) and compared. Failure was defined as the need of invasive procedure. Calculated area under receiver operating characteristic (ROC) curves and thresholds of bleeding at 10 min were also calculated for prediction of failure. 127 women were included. The overall success rate was 78.0 % (95 % CI 70.7-85.1 %). Blood loss at 10 min was factor prognostic of early IUBT failure. The ROC curve of blood loss at 10 min for prediction of failure of IUBT had an area under the curve of 0.876 (95 % CI 0.782-0.970). The predictive positive value of blood loss at 10 min were respectively 0.53, 0.8 and 0.94 for blood loss of 100, 200 and 250 mL. Physicians should be alerted if blood loss are more than 200 mL at 10 min after placement of IUBT and considered invasive procedure if more than 250 mL to avoid delaying management of PPH.
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Affiliation(s)
- A Leleu
- CHU Lille, Department of Obstetrics, F-59000, Lille, France
| | - L Ghesquiere
- CHU Lille, Department of Obstetrics, F-59000, Lille, France; University of Lille, EA 4489 - Perinatal Environment and Health, F-59000, Lille, France
| | - F Machuron
- University of Lille, CHU Lille, EA 2694 - Public Health: Epidemiology and Quality of Care, Department of Biostatistics, F-59000, Lille, France
| | - C Caudrelier
- CHU Lille, Department of Obstetrics, F-59000, Lille, France
| | - P Devouge
- CH Valenciennes, Department of Obstetrics, F-59000, Valenciennes, France
| | - D Subtil
- CHU Lille, Department of Obstetrics, F-59000, Lille, France; University of Lille, CHU Lille, EA 2694 - Public Health: Epidemiology and Quality of Care, Department of Biostatistics, F-59000, Lille, France
| | - V Houflin-Debarge
- CHU Lille, Department of Obstetrics, F-59000, Lille, France; University of Lille, EA 4489 - Perinatal Environment and Health, F-59000, Lille, France
| | - C Garabedian
- CHU Lille, Department of Obstetrics, F-59000, Lille, France; University of Lille, EA 4489 - Perinatal Environment and Health, F-59000, Lille, France.
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6
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The Discriminant Use of Intrauterine Balloon Tamponade and Compression Sutures for Management of Major Postpartum Hemorrhage: Comparison of Patient Characteristics and Clinical Outcome. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6648829. [PMID: 33490275 PMCID: PMC7801069 DOI: 10.1155/2021/6648829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 11/17/2022]
Abstract
Background Intrauterine balloon tamponade (IUBT) and compression sutures have been widely used in recent years in the management of postpartum hemorrhage (PPH). However, there is scant literature directly comparing the clinical scenarios that led to the discriminant selection of these management modalities and the direct clinical outcomes. The purpose of this study is to compare the patient characteristics and clinical risk factors that led to the use of IUBT and compression sutures in the management of major PPH as well as the immediate outcome in a retrospective cohort. Methods Patients who had IUBT or compression sutures applied due to major PPH (>1000 ml) from 2014 to 2018 in a single obstetric unit were recruited. The patient characteristics and clinical outcome of the two groups were compared. Results A total of 67 patients had IUBT and 29 patients had compression sutures applied as the first uterine sparing technique. Apart from more vaginal deliveries (25.4% vs. 3.5%) in the IUBT group compared to compression sutures, there were no significant differences between the two groups in terms of patient characteristics. The IUBT group had a slightly higher blood loss at the start of the uterine sparing procedure (239 ml, p = 0.049) and received more transfusions, despite no differences in the total blood loss, hemogloblin level, incidence of coagulopathy, and intensive care unit admission between the two groups. There was no significant difference in the overall success rate between IUBT and compression sutures to control PPH without additional surgical intervention or hysterectomy (73.1% vs. 55.1%, p = 0.15) or the success rate for PPH due to uterine atony (32.8% vs. 20.7%), though IUBT apparently performed better than compression sutures in cases of placenta praevia (77.3% vs. 16.7%, p = 0.01). Blood loss > 1.5 l at the start of the procedure, presence of placenta accreta, and presence of coagulopathy were found to be significant poor prognostic factors for both procedures to control PPH. Conclusions There were no dominating patient characteristics that favoured the selection of either IUBT or compression sutures in the management of severe PPH except for the mode of delivery. Both procedures had equally high overall success rates to control PPH, but IUBT performed better in placenta praevia cases as compared to compression sutures.
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Dorkham MC, Epee-Bekima MJ, Sylvester HC, White SW. Experience of Bakri balloon tamponade at a single tertiary centre: a retrospective case series. J OBSTET GYNAECOL 2020; 41:854-859. [PMID: 33063565 DOI: 10.1080/01443615.2020.1799341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Intrauterine balloon tamponade (IUBT) is an established fertility-sparing and life-saving treatment for postpartum haemorrhage. However, high-level evidence is lacking for specific aspects of its use. Our aim was to evaluate a large case series of IUBT to inform evidence-based clinical practice. 296 cases of IUBT over a three-year period at a tertiary obstetric referral centre were identified and reviewed. Demographic, clinical, and procedural outcome measures were collected; including rates of success and failure of IUBT, duration of tamponade, and complications. IUBT was successful in 265 (90%) of women and failed in 18 (6%). All failures occurred within six hours of balloon insertion. Once deemed stable and successful at six hours, no women required return to theatre or further intervention. The mean duration of intrauterine balloon tamponade was 18.5 hours. A large variance in clinical practice exists including duration of intrauterine balloon tamponade, and method and timing of removal. A number of changes informed by the results will be introduced and prospectively audited to improve IUBT use.Impact statementWhat is already known on this subject? Intrauterine balloon tamponade (IUBT) is an important second-line treatment option in severe postpartum haemorrhage (PPH). IUBT is easy to use, is effective especially in the setting of uterine atony, and is associated with minimal complications.What the results of this study add? This study confirms the high rate of success for IUBT in controlling PPH. We found that after six hours, if deemed successful, it is rare that further intervention is required. In addition, tamponade beyond 12 hours, gradual or incremental deflation of the balloon, and antibiotic cover beyond the duration of tamponade are unlikely to yield any further safety benefit.What the implications are of these findings for clinical practice and/or further research? Our findings suggest that women should not be required to fast for balloon removal; removal of the balloon should occur by 12 hours if deemed stable and adequately resuscitated; deflation and removal of the balloon can occur at once; and antibiotics should be ceased after balloon removal. These will allow women to mobilise and recover sooner, and improve flow and throughput in our high-acuity care areas.
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Affiliation(s)
- Mariana C Dorkham
- Division of Obstetrics, Gynaecology and Imaging Directorate, King Edward Memorial Hospital, Perth, Australia
| | - Mathias J Epee-Bekima
- Division of Obstetrics, Gynaecology and Imaging Directorate, King Edward Memorial Hospital, Perth, Australia
| | - Hannah C Sylvester
- Division of Obstetrics, Gynaecology and Imaging Directorate, King Edward Memorial Hospital, Perth, Australia
| | - Scott W White
- Division of Obstetrics, Gynaecology and Imaging Directorate, King Edward Memorial Hospital, Perth, Australia.,Division of Obstetrics & Gynaecology, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
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Suarez S, Conde-Agudelo A, Borovac-Pinheiro A, Suarez-Rebling D, Eckardt M, Theron G, Burke TF. Uterine balloon tamponade for the treatment of postpartum hemorrhage: a systematic review and meta-analysis. Am J Obstet Gynecol 2020; 222:293.e1-293.e52. [PMID: 31917139 DOI: 10.1016/j.ajog.2019.11.1287] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/12/2019] [Accepted: 11/18/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess the efficacy, effectiveness, and safety of uterine balloon tamponade for treating postpartum hemorrhage. STUDY DESIGN We searched electronic databases (from their inception to August 2019) and bibliographies. We included randomized controlled trials, nonrandomized studies, and case series that reported on the efficacy, effectiveness, and/or safety of uterine balloon tamponade in women with postpartum hemorrhage. The primary outcome was the success rate of uterine balloon tamponade for treating postpartum hemorrhage (number of uterine balloon tamponade success cases/total number of women treated with uterine balloon tamponade). For meta-analyses, we calculated pooled success rate for all studies, and relative risk with 95% confidence intervals for studies that included a comparative arm. RESULTS Ninety-one studies, including 4729 women, met inclusion criteria (6 randomized trials, 1 cluster randomized trial, 15 nonrandomized studies, and 69 case series). The overall pooled uterine balloon tamponade success rate was 85.9% (95% confidence interval, 83.9-87.9%). The highest success rates corresponded to uterine atony (87.1%) and placenta previa (86.8%), and the lowest to placenta accreta spectrum (66.7%) and retained products of conception (76.8%). The uterine balloon tamponade success rate was lower in cesarean deliveries (81.7%) than in vaginal deliveries (87.0%). A meta-analysis of 2 randomized trials that compared uterine balloon tamponade vs no uterine balloon tamponade in postpartum hemorrhage due to uterine atony after vaginal delivery showed no significant differences between the study groups in the risk of surgical interventions or maternal death (relative risk, 0.59; 95% confidence interval, 0.02-16.69). A meta-analysis of 2 nonrandomized before-and-after studies showed that introduction of uterine balloon tamponade in protocols for managing severe postpartum hemorrhage significantly decreased the use of arterial embolization (relative risk, 0.29; 95% confidence interval, 0.14-0.63). A nonrandomized cluster study reported that use of invasive procedures was significantly lower in the perinatal network that routinely used uterine balloon tamponade than that which did not use uterine balloon tamponade (3.0/1000 vs 5.1/1000; P < .01). A cluster randomized trial reported that the frequency of postpartum hemorrhage-related invasive procedures and/or maternal death was significantly higher after uterine balloon tamponade introduction than before uterine balloon tamponade introduction (11.6/10,000 vs 6.7/10,000; P = .04). Overall, the frequency of complications attributed to uterine balloon tamponade use was low (≤6.5%). CONCLUSION Uterine balloon tamponade has a high success rate for treating severe postpartum hemorrhage and appears to be safe. The evidence on uterine balloon tamponade efficacy and effectiveness from randomized and nonrandomized studies is conflicting, with experimental studies suggesting no beneficial effect, in contrast with observational studies. Further research is needed to determine the most effective programmatic and healthcare delivery strategies on uterine balloon tamponade introduction and use.
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Affiliation(s)
- Sebastian Suarez
- Division of Global Health Innovation, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Internal Medicine, Boston Medical Center, Boston, Massachusetts.
| | - Agustin Conde-Agudelo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan
| | - Anderson Borovac-Pinheiro
- Division of Global Health Innovation, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas (SP), Brazil
| | - Daniela Suarez-Rebling
- Division of Global Health Innovation, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Melody Eckardt
- Division of Global Health Innovation, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Gerhard Theron
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Thomas F Burke
- Division of Global Health Innovation, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Park JE, Park JK, Jo HC, Cho IA, Baek JC. The association between intrauterine balloon tamponade volume and postpartum hemorrhage outcomes. Int J Gynaecol Obstet 2019; 148:325-330. [PMID: 31778210 DOI: 10.1002/ijgo.13069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/23/2019] [Accepted: 11/26/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the effect of intrauterine balloon tamponade (IUBT) on the outcomes of postpartum hemorrhage (PPH) according to the balloon volume and to investigate the clinical factors associated with poor PPH outcomes. METHODS A retrospective cohort study was conducted in which patients with PPH underwent IUBT from January 2016 to August 2018. Patients with an IUBT volume greater than 350 mL (n=76) were compared to patients with an IUBT volume less than 350 mL (n=213). The clinical outcomes related to PPH included blood transfusion, estimated blood loss (EBL) after balloon placement, uterine artery embolization (UAE) after IUBT, and postpartum hospitalization. The results were analyzed by multivariate logistic regression models. RESULTS None of the clinical outcomes related to PPH and evaluated in our study were favorable in patients with an IUBT volume greater than 350 mL. Other factors associated with poor PPH outcomes after IUBT were placental site hemorrhage, shock index (SI) before IUBT, and antenatal hemoglobin. CONCLUSION It is better to avoid unnecessary balloon inflation in IUBT if the bleeding is reduced, and more attention should be paid to the procedure when the balloon is large (≥350 mL) than when it is small (<350 mL).
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Affiliation(s)
- Ji Eun Park
- Department of Obstetrics and Gynecology, College of Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University, Changwon, Republic of Korea
| | - Ji Kwon Park
- Department of Obstetrics and Gynecology, College of Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University, Changwon, Republic of Korea
| | - Hyen Chul Jo
- Department of Obstetrics and Gynecology, College of Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University, Changwon, Republic of Korea
| | - In Ae Cho
- Department of Obstetrics and Gynecology, College of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jong Chul Baek
- Department of Obstetrics and Gynecology, College of Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University, Changwon, Republic of Korea
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Escobar MF, Suso JP, Hincapié MA, Echavarría MP, Fernández P, Carvajal J. Experience of combined use of a Bakri uterine balloon and a non‐pneumatic anti‐shock garment in a university hospital in Colombia. Int J Gynaecol Obstet 2019; 146:244-249. [DOI: 10.1002/ijgo.12872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 02/28/2019] [Accepted: 05/24/2019] [Indexed: 11/09/2022]
Affiliation(s)
- María F. Escobar
- High Complexity Obstetric UnitDepartment of Gynecology & ObstetricsFundación Valle del Lili Cali Colombia
- Postgraduate DepartmentFaculty of Health SciencesIcesi University Cali Colombia
| | - Juan P. Suso
- Postgraduate DepartmentFaculty of Health SciencesIcesi University Cali Colombia
| | - María A. Hincapié
- Postgraduate DepartmentFaculty of Health SciencesIcesi University Cali Colombia
| | - María P. Echavarría
- High Complexity Obstetric UnitDepartment of Gynecology & ObstetricsFundación Valle del Lili Cali Colombia
- Postgraduate DepartmentFaculty of Health SciencesIcesi University Cali Colombia
| | - Paula Fernández
- Centro de Investigaciones ClínicasFundación Valle del Lili Cali Colombia
| | - Javier Carvajal
- High Complexity Obstetric UnitDepartment of Gynecology & ObstetricsFundación Valle del Lili Cali Colombia
- Postgraduate DepartmentFaculty of Health SciencesIcesi University Cali Colombia
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Grange J, Chatellier M, Chevé MT, Paumier A, Launay-Bourillon C, Legendre G, Olivier M, Ducarme G. Predictors of failed intrauterine balloon tamponade for persistent postpartum hemorrhage after vaginal delivery. PLoS One 2018; 13:e0206663. [PMID: 30365539 PMCID: PMC6203390 DOI: 10.1371/journal.pone.0206663] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 10/17/2018] [Indexed: 11/18/2022] Open
Abstract
Objective To identify the predictors of intrauterine balloon tamponade (IUBT) failure for persistent postpartum hemorrhage (PPH) after vaginal delivery. Design Retrospective case-series in five maternity units in a perinatal network. Setting All women who underwent IUBT for persistent PPH after vaginal delivery from January 2011 to December 2015 in these hospitals. Methods All maternity apply the same management policy for PPH. IUBT, using a Bakri balloon, was used as a second line therapy for persistent PPH after failure of bimanual uterine massage and uterotonics to stop bleeding after vaginal delivery. Women who required another second line therapy (embolization or surgical procedures) to stop bleeding after IUBT were defined as cases, and women whom IUBT stopped bleeding were defined as control group. We determined independent predictors for failed IUBT using multiple regression and adjusting for demographics with adjusted odds ratios (aORs) and 95% confidence intervals (95% CI). Results During the study period, there were 91,880 deliveries in the five hospitals and IUBT was used in 108 women to control bleeding. The success rate was 74.1% (80/108). In 28 women, invasive procedures were required (19 embolization and 9 surgical procedures with 5 peripartum hysterectomies). Women with failed IUBT were more often obese (25.9% vs. 8.1%; p = 0.03), duration of labor was shorter (363.9 min vs. 549.7min; p = 0.04), and major PPH (≥1,500 mL) before IUBT was more frequent (64% vs. 40%; p = 0.04). Obesity was a predictive factor of failed IUBT (aOR 4.40, 95% CI 1.06–18.31). Major PPH before IUBT seemed to be another predictor of failure (aOR 1.001, 95% CI 1.000–1.002), but our result did not reach statistical significativity. Conclusion Intrauterine balloon tamponade is an effective second line therapy for persistent primary PPH after vaginal delivery. Pre-pregnancy obesity is a risk factor of IUBT failure.
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Affiliation(s)
- Joséphine Grange
- Department of Obstetrics and Gynecology, Centre Hospitalier Départemental, La Roche sur Yon, France
| | | | - Marie-Thérèse Chevé
- Department of Obstetrics and Gynecology, Le Mans General Hospital, Le Mans, France
| | - Anne Paumier
- Department of Obstetrics and Gynecology, Atlantic Polyclinic, Saint-Herblain, France
| | | | - Guillaume Legendre
- Department of Obstetrics and Gynecology, Angers University Hospital, Angers, France
| | - Marion Olivier
- Réseau Sécurité Naissance des Pays de la Loire, Nantes, France
| | - Guillaume Ducarme
- Department of Obstetrics and Gynecology, Centre Hospitalier Départemental, La Roche sur Yon, France
- * E-mail:
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Wang D, Xu S, Qiu X, Zhu C, Li Z, Wang Z, Hou H, Gao Y, Wang X, He P, Qin Y, Liu L. Early usage of Bakri postpartum balloon in the management of postpartum hemorrhage: a large prospective, observational multicenter clinical study in South China. J Perinat Med 2018; 46:649-656. [PMID: 29252201 DOI: 10.1515/jpm-2017-0249] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 10/02/2017] [Indexed: 11/15/2022]
Abstract
AIM To evaluate the success rate and protocol of the Bakri balloon for postpartum hemorrhage (PPH) in the course of a prospective observational multicenter cohort study in South China. METHODS At 20 hospitals in South China, women with postpartum bleeding who failed to respond to the first-line conservative management and received the Bakri balloon were recruited for the study. Maternal characteristics, PPH characteristics, PPH management and outcomes in regard to the Bakri balloon use were recorded. RESULTS A total of 472 women had a Bakri balloon tamponade and 407 (86.23%) women were enrolled (67 after vaginal delivery and 340 either during or after cesarean delivery). The success rate of the Bakri balloon in this study was 91.65% (373/407 women). During vaginal deliveries, the group with a hemorrhage >2000 mL before balloon insertion had significantly more blood loss (551.67±635.17 mL vs. 242.06±313.69 mL, P=0.039) and lower maternal hemoglobin (73±21.77 g/L vs. 92.06±19.60 g/L, P=0.029) after using Bakri balloon than the group with a hemorrhage <1000 mL. Similar data were found during cesarean deliveries. The blood loss before and after balloon insertion were significantly higher in the Bakri balloon failure group (1700±1429.88 mL before and 1209.58±1139.72 mL after using the balloon) than those in the success group [918±493.92 mL before (P=0.002) and 266.57±361.60 mL after using the balloon (P=0.001)]. CONCLUSION Rapid diagnosis or prognosis of PPH, in combination with early usage of the Bakri postpartum balloon is more effective for the management of PPH.
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Affiliation(s)
- Dongyu Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shuqia Xu
- Department of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiwen Qiu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Caixia Zhu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhuyu Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zilian Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Hongying Hou
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yu Gao
- Department of Obstetrics and Gynecology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiaoyi Wang
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Ping He
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Yiwei Qin
- Department of Obstetrics and Gynecology, Huadu District People's Hospital of Guangzhou, Guangzhou, Guangdong, China
| | - Lihua Liu
- Department of Obstetrics and Gynecology, Shenzhen Maternity & Child Healthcare Hospital, Shenzhen, Guangdong, China
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Henriquez DDCA, Bloemenkamp KWM, van der Bom JG. Management of postpartum hemorrhage: how to improve maternal outcomes? J Thromb Haemost 2018; 16:S1538-7836(22)02220-6. [PMID: 29883040 DOI: 10.1111/jth.14200] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Indexed: 01/18/2023]
Abstract
Postpartum hemorrhage is the leading cause of maternal mortality and severe morbidity. Despite efforts to improve maternal outcomes, management of postpartum hemorrhage still faces at least four challenges, discussed in this review. First, current definitions for severe postpartum hemorrhage hamper early identification of women with a high risk of adverse outcomes. Adaptations to the definitions and the use of clinical tools such as shock index and early warning systems may facilitate this early identification. Second, surgical and radiological interventions to prevent hysterectomy are not always successful. More knowledge on the influence of patient and bleeding characteristics on the success rates of these interventions is necessary. Scarce data suggest that early timing of intrauterine balloon tamponade may improve maternal outcomes, whereas early timing of arterial embolization seems to be unrelated to maternal outcomes. Third, fluid resuscitation with crystalloids and colloids is unavoidable in the early phases of postpartum hemorrhage but may result in dilutional coagulopathy. Effects of different volumes of clear fluids on the occurrence of dilutional coagulopathy and maternal outcomes is unknown. Fourth, a better understanding of diagnosis and correction of coagulopathy during postpartum hemorrhage is needed. Low plasma fibrinogen levels at the start of postpartum hemorrhage predict progression to severe hemorrhage, but standard coagulation screens are time consuming. A solution may be point-of-care coagulation testing; however, clinical usefulness during postpartum hemorrhage has not been demonstrated. To date, early administration of tranexamic acid is the only hemostatic intervention that was proven to improve outcomes in women with postpartum hemorrhage.
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Affiliation(s)
- D D C A Henriquez
- Center for Clinical Transfusion Research, Sanquin Research and Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - K W M Bloemenkamp
- Department of Obstetrics, Birth Center, Wilhelmina's Children Hospital, Division Woman and Baby, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J G van der Bom
- Center for Clinical Transfusion Research, Sanquin Research and Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
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Shinohara S, Okuda Y, Hirata S. Association between birth weight and massive haemorrhage in pregnancy with a low-lying placenta: a 9-year single-centre retrospective cohort study in Japan. J OBSTET GYNAECOL 2018; 39:22-26. [PMID: 29884097 DOI: 10.1080/01443615.2018.1454413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
A low-lying placenta is a well-known cause of a massive intrapartum haemorrhage. We aimed to evaluate whether neonatal birth weight deviation from the nationwide average could predict a massive haemorrhage during a delivery in the women with a low-lying placenta. This study included 40 women. The main outcomes were a massive haemorrhage and a neonatal birth weight deviation. We used a receiver operating characteristic curve analysis to determine the optimal birth weight deviation cut-off for predicting a massive haemorrhage. A multiple logistic regression model was used to identify the variables significantly associated with a massive haemorrhage. The best cut-off for predicting a massive haemorrhage was a birth weight deviation of +0.51 standard deviations (SDs) from the nationwide average. A birth weight deviation of ≥ +0.51 SDs was significantly associated with an increased massive haemorrhage risk. Impact statement What is already known on this subject? A low-lying placenta is a well-known cause of a massive intrapartum haemorrhage. Therefore, when managing pregnancies with a low-lying placenta, the possibility of severe perinatal bleeding should be considered, and it is desirable to determine reliable predictors of a haemorrhage. However, few studies have reported the predictive factors of a massive haemorrhage in patients with a low-lying placenta. What do the results of this study add? We demonstrated that a birth weight deviation from the nationwide average was significantly associated with a massive intrapartum haemorrhage in patients with a low-lying placenta. To our knowledge, this is the first study to clarify the association between a neonatal birth weight and a massive intrapartum haemorrhage incidence and to determine the optimal birth weight deviation cut-off for predicting a massive haemorrhage in patients with a low-lying placenta. What are the implications of these findings for clinical practice and/or further research? An accurate risk stratification using the foetal weight as a marker for a predicting massive intrapartum haemorrhage may help in the management of patients with a low-lying placenta. Studies with a larger sample size are required to confirm our findings.
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Affiliation(s)
- Satoshi Shinohara
- a Department of Obstetrics and Gynecology, Faculty of Medicine , University of Yamanashi , Chuo , Japan
| | - Yasuhiko Okuda
- a Department of Obstetrics and Gynecology, Faculty of Medicine , University of Yamanashi , Chuo , Japan
| | - Shuji Hirata
- a Department of Obstetrics and Gynecology, Faculty of Medicine , University of Yamanashi , Chuo , Japan
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15
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Ramanathan A, Eckardt MJ, Nelson BD, Guha M, Oguttu M, Altawil Z, Burke T. Safety of a condom uterine balloon tamponade (ESM-UBT) device for uncontrolled primary postpartum hemorrhage among facilities in Kenya and Sierra Leone. BMC Pregnancy Childbirth 2018; 18:168. [PMID: 29764416 PMCID: PMC5952618 DOI: 10.1186/s12884-018-1808-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 04/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postpartum hemorrhage is the leading cause of maternal mortality in low- and middle-income countries. While evidence on uterine balloon tamponade efficacy for severe hemorrhage is encouraging, little is known about safety of this intervention. The objective of this study was to evaluate the safety of an ultra-low-cost uterine balloon tamponade package (named ESM-UBT) for facility-based management of uncontrolled postpartum hemorrhage (PPH) in Kenya and Sierra Leone. METHODS Data were collected on complications/adverse events in all women who had an ESM-UBT device placed among 92 facilities in Sierra Leone and Kenya, between September 2012 and December 2015, as part of a multi-country study. Three expert maternal health investigator physicians analyzed each complication/adverse event and developed consensus on whether there was a potential causal relationship associated with use of the ESM-UBT device. Adverse events/complications specifically investigated included death, hysterectomy, uterine rupture, perineal or cervical injury, serious or minor infection, and latex allergy/anaphylaxis. RESULTS Of the 201 women treated with an ESM-UBT device in Kenya and Sierra Leone, 189 (94.0%) survived. Six-week or longer follow-up was recorded in 156 of the 189 (82.5%). A causal relationship between use of an ESM-UBT device and one death, three perineal injuries and one case of mild endometritis could not be completely excluded. Three experts found a potential association between these injuries and an ESM-UBT device highly unlikely. CONCLUSION The ESM-UBT device appears safe for use in women with uncontrolled PPH. TRIAL REGISTRATION Trial registration was not completed as data was collected as a quality assurance measure for the ESM-UBT kit.
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Affiliation(s)
- Aparna Ramanathan
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua St, Suite 910, Boston, MA, 02114, USA. .,Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Melody J Eckardt
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua St, Suite 910, Boston, MA, 02114, USA
| | - Brett D Nelson
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua St, Suite 910, Boston, MA, 02114, USA.,Harvard Medical School, Boston, MA, USA
| | - Moytrayee Guha
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua St, Suite 910, Boston, MA, 02114, USA
| | | | - Zaid Altawil
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua St, Suite 910, Boston, MA, 02114, USA
| | - Thomas Burke
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua St, Suite 910, Boston, MA, 02114, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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16
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Kong CW, To WW. Prognostic factors for the use of intrauterine balloon tamponade in the management of severe postpartum hemorrhage. Int J Gynaecol Obstet 2018; 142:48-53. [PMID: 29603742 DOI: 10.1002/ijgo.12498] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 01/30/2018] [Accepted: 03/29/2018] [Indexed: 11/06/2022]
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.
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Affiliation(s)
- Choi Wah Kong
- Department of Obstetrics and Gynecology, United Christian Hospital, Hong Kong, China
| | - William W To
- Department of Obstetrics and Gynecology, United Christian Hospital, Hong Kong, China
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17
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Kong CW, To WWK. Intraluminal pressure of uterine balloon tamponade in the management of severe post-partum hemorrhage. J Obstet Gynaecol Res 2018; 44:914-921. [PMID: 29392798 DOI: 10.1111/jog.13596] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 12/31/2017] [Indexed: 11/30/2022]
Abstract
AIM Intrauterine balloon tamponade has been increasingly used for the management of post-partum hemorrhage (PPH) in recent years. However, data on the precise mechanisms and pressure required for the balloon tamponade are scanty in the literature. This study aims to review the intraluminal pressure (ILP) generated by the Bakri intrauterine balloon that is necessary to produce a 'positive tamponade test' during severe PPH. METHODS This was a prospective cohort study. The ILP of the Bakri balloon was measured using a manometer after a positive tamponade test was clinically achieved during severe PPH (blood loss >1 L). The patient's blood pressure was recorded, and ultrasound scan was performed to verify the position of the balloon and the presence of forward flow in the uterine arteries. The main outcome measure is the ILP of the Bakri balloon required to achieve a positive tamponade test. RESULTS Twenty patients were included for final analysis. The net ILP measured ranged from 67 to 92 mmHg, and this pressure was lower than the concurrent systolic pressure in all cases. Color Doppler confirmed positive forward flow in the uterine vessels in all cases. There were no differences in the pressure measured with the balloon position, and there was no relationship between the volumes of saline infused and the net pressure. CONCLUSION A positive tamponade test in an intrauterine balloon is probably achieved by local compression pressure exerted on the vasculature of the placental bed rather than by generating an ILP exceeding systemic blood pressure or by occlusion of flow to the uterine arteries.
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Affiliation(s)
- Choi Wah Kong
- Department of Obstetrics and Gynaecology, United Christian Hospital, Hong Kong
| | - William W K To
- Department of Obstetrics and Gynaecology, United Christian Hospital, Hong Kong
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18
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Nakashima A, Ogita K, Chita M, Yokoi T. Serum fibrinogen levels could be an index of successful use of balloon tamponade in postpartum hemorrhage. J Perinat Med 2018; 46:53-57. [PMID: 28245191 DOI: 10.1515/jpm-2016-0238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 01/23/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The object of our study was to determine whether serum fibrinogen levels could be used to predict the success rates of balloon tamponade and decrease the use of invasive methods. METHODS This retrospective study, conducted at Rinku General Medical Center, was aimed to identify factors associated with high success rates in balloon tamponade. Forty-six patients with postpartum hemorrhage (PPH), non-responsive to uterotonics and treated with balloon tamponade between April 2008 and March 2015, were included. RESULTS Forty-six women were included, of which 34 underwent vaginal delivery and 12 underwent cesarean delivery. There were no complications from balloon tamponade and its success rate was 73.3%. Seven women required additional procedures: One used gauze packing, three used uterine artery embolization, and five underwent peripartum hysterectomy. The cut-off line of serum fibrinogen level was 172.5 mg/dL (P=0.002) with its 77.4% sensitivity and 66.7% specificity. CONCLUSION We recommend measuring serum fibrinogen level for predicting whether the balloon tamponade can be used successfully or not.
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Affiliation(s)
- Ayaka Nakashima
- Department of Obstetrics and Gynecology, Rinku General Medical Center Senshu Regional Medical Center for Women and Children's Health, Izumisano-shi, Osaka, Japan
| | - Kazuhide Ogita
- Department of Obstetrics and Gynecology, Rinku General Medical Center Senshu Regional Medical Center for Women and Children's Health, Rinku Ourai Kita 2-23, Izumisano-shi, Osaka 598-8577, Japan, Phone: +81-72-469-3111, Fax: +81-72-469-7929
| | - Masaya Chita
- Department of Obstetrics and Gynecology, Saitama Red Cross Hospital, Chuo-ku, Saitama-shi, Saitama, Japan
| | - Takeshi Yokoi
- Department of Obstetrics and Gynecology, Kaizuka City Hospital Senshu Regional Medical Center for Women and Children's Health, Kaizuka-shi, Osaka, Japan
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Tahaoglu AE, Balsak D, Erdogdu E, Bakır MS, Aksin S, Bala M, Togrul C, Yalınkaya A. Bakri balloon placement effectively treats uterine atony and placenta previa. BIOTECHNOL BIOTEC EQ 2017. [DOI: 10.1080/13102818.2017.1298467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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20
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Darwish AM, Abdallah MM, Shaaban OM, Ali MK, Khalaf M, Sabra AMA. Bakri balloon versus condom-loaded Foley’s catheter for treatment of atonic postpartum hemorrhage secondary to vaginal delivery: a randomized controlled trial. J Matern Fetal Neonatal Med 2017; 31:747-753. [PMID: 28274173 DOI: 10.1080/14767058.2017.1297407] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Atef M. Darwish
- Woman’s Health University Hospital, Assiut University, Assiut, Egypt
| | | | - Omar M. Shaaban
- Woman’s Health University Hospital, Assiut University, Assiut, Egypt
| | - Mohammed K. Ali
- Woman’s Health University Hospital, Assiut University, Assiut, Egypt
| | - Mohamed Khalaf
- Woman’s Health University Hospital, Assiut University, Assiut, Egypt
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21
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Ogoyama M, Takahashi H, Usui R, Baba Y, Suzuki H, Ohkuchi A, Matsubara S. Hemostatic effect of intrauterine balloon for postpartum hemorrhage with special reference to concomitant use of “holding the cervix” procedure (Matsubara). Eur J Obstet Gynecol Reprod Biol 2017; 210:281-285. [DOI: 10.1016/j.ejogrb.2017.01.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 01/09/2017] [Indexed: 11/16/2022]
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22
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Lo A, St. Marie P, Yadav P, Belisle E, Markenson G. The impact of Bakri balloon tamponade on the rate of postpartum hysterectomy for uterine atony. J Matern Fetal Neonatal Med 2016; 30:1163-1166. [DOI: 10.1080/14767058.2016.1208742] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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