Impact of intrauterine balloon tamponade on emergency peripartum hysterectomy following vaginal delivery

Abstract

Objective: To assess the impact of intrauterine balloon tamponade as a second-line technique before resorting to emergency peripartum hysterectomy in cases with severe postpartum hemorrhage and uterotonic treatment failure following vaginal delivery.

Study design: A retrospective, monocentric study evaluating cases of uterotonic treatment failure with severe postpartum hemorrhage following vaginal delivery between January 2005 and June 2018. Cases of cesarean section, amniotic embolism, uterine rupture, placenta accreta, and postpartum hemorrhage by vaginal laceration were excluded. The primary study outcome was incidence of emergency peripartum hysterectomy before and after use of intrauterine balloon tamponade was initiated.

Results: Among the 55,776 women who gave birth vaginally at our site during the study period, 161 (0.3 %) had severe postpartum hemorrhage with medical treatment failure (78 during the period prior to intrauterine balloon tamponade use, and 83 after intrauterine balloon tamponade use was initiated). The intrauterine balloon tamponade failure rate was 21.9 % (n = 18). Emergency peripartum hysterectomy was performed in 7 cases prior to intrauterine balloon tamponade use and 2 cases during use of intrauterine balloon tamponade. Thus, we observed a nonsignificant decrease in emergency peripartum hysterectomy after use of intrauterine balloon tamponade was implemented (9.0 % vs. 2.4 %, p = 0.09). However, the decrease was significant among patients who underwent conservative surgical treatment before intrauterine balloon tamponade use (53.8 % vs. 12.5 %, p = 0.041).

Conclusions: Though we did not find a significant overall reduction in emergency peripartum hysterectomy following implementation of intrauterine balloon tamponade, there was a decrease in these cases when conservative surgical treatment was followed by intrauterine balloon tamponade.

Keywords: Hemostatic hysterectomy; Intrauterine balloon tamponade; Postpartum hemorrhage; Vaginal delivery.