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Prognostic factors for the use of intrauterine balloon tamponade in the management of severe postpartum hemorrhage
Author(s) -
Kong Choi Wah,
To William W.
Publication year - 2018
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.12498
Subject(s) - medicine , balloon tamponade , hysterectomy , retrospective cohort study , univariate analysis , obstetrics , tamponade , blood loss , surgery , placenta accreta , adverse effect , coagulopathy , consumptive coagulopathy , pregnancy , multivariate analysis , fetus , placenta , biology , genetics
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.