The association between intrauterine balloon tamponade duration and postpartum hemorrhage outcomes

• Published in: American journal of obstetrics and gynecology 2017-03, Vol.216 (3), p.300.e1-300.e5
• Main Authors: Einerson, Brett D., MD, MPH, Son, Moeun, MD, Schneider, Patrick, MD, Fields, Ian, MD, Miller, Emily S., MD, MPH
• Format: Article
• Language: English
• Subjects: Adult; Balloon Occlusion; Cohort Studies; Female; Humans; Hysterectomy; intrauterine balloon tamponade; Obstetrics and Gynecology; postpartum hemorrhage; Postpartum Hemorrhage - therapy; Retrospective Studies; Time Factors; Treatment Outcome; Uterine Artery Embolization - methods
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2016.10.040

Background Intrauterine balloon tamponade is an effective treatment for postpartum hemorrhage when first-line treatments fail. The optimal duration of intrauterine balloon tamponade for management of postpartum hemorrhage is unclear. Objective The objective of the study was to determine whether intrauterine balloon tamponade removal >12 hours of duration is associated with postpartum hemorrhage–related clinical outcomes. Study Design This was a retrospective cohort study of women with postpartum hemorrhage from 2007 through 2014 who underwent intrauterine balloon tamponade. We excluded failures of intrauterine balloon tamponade (intrauterine balloon expulsion with duration 12 hours. Examined postpartum hemorrhage–related clinical outcomes included estimated blood loss after intrauterine balloon tamponade placement, blood product transfusion, use of adjuvant measures to control postpartum hemorrhage after intrauterine balloon tamponade (either uterine artery embolization or hysterectomy), and maternal intensive care unit admission. Secondary outcomes examined included postpartum fever and hospital length of stay. Multivariable logistic regression models were used to control for confounding variables. Results Of 274 eligible women, 206 (75%) underwent intrauterine balloon tamponade for >12 hours and 68 (25%) underwent intrauterine balloon tamponade for 2–12 hours. The median estimated blood loss after intrauterine balloon tamponade placement (190 vs 143 mL, P  = .116) as well as the frequencies of blood product transfusion (62.1% vs 51.5%, P  = .120), transfusion of ≥4 U of packed red blood cells (17.0% vs 14.7%, P  = .659), uterine artery embolization (15.1% vs 16.2%, P  = .823), hysterectomy (0.0% vs 1.5%, P  = .248), and intensive care unit admission (8.7% vs 7.4%, P  = .721), was not statistically different between the groups, and this lack of association persisted in multivariable regressions. Intrauterine balloon tamponade duration >12 hours was associated with a higher frequency of postpartum fever (27% vs 15%, P  = .047) and a longer mean hospital length of stay (3.7 vs 3.1 days, P  = .002). After adjusting for variables that differed statistically between groups, the difference in length of stay associated with intrauter