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Patrick Rozenberg - One of the best experts on this subject based on the ideXlab platform.
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Intrauterine Balloon Tamponade for Severe Postpartum Hemorrhage.
Obstetrics and gynecology, 2018Co-Authors: Mathilde Revert, Patrick Rozenberg, Jonathan Cottenet, Catherine QuantinAbstract:OBJECTIVE To compare the rates of invasive procedures (surgical or vascular) for hemorrhage control between a perinatal network that routinely used Intrauterine Balloon tamponade and another perinatal network that did not in postpartum hemorrhage management. METHODS This population-based retrospective cohort study included all women (72,529) delivering between 2011 and 2012 in the 19 maternity units in two French perinatal networks: a pilot (in which Balloon tamponade was used) and a control network. Outcomes were assessed based on discharge abstract data from the national French medical information system. General and obstetric characteristics were included in two separate multivariate logistic models according to the mode of delivery (vaginal and cesarean) to estimate the independent association of the network with invasive procedures. RESULTS Invasive procedures (pelvic vessel ligation, arterial embolization, hysterectomy) were used in 298 women and in 4.1 per 1,000 deliveries (95% CI 3.7-4.6). The proportion of women with at least one invasive procedure was significantly lower in the pilot network (3.0/1,000 vs 5.1/1,000, P
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Intrauterine Balloon tamponade for severe postpartum hemorrhage
Obstetrics & Gynecology, 2017Co-Authors: Mathilde Revert, Patrick Rozenberg, Jonathan Cottenet, Catherine QuantinAbstract:OBJECTIVE To compare the rates of invasive procedures (surgical or vascular) for hemorrhage control between a perinatal network that routinely used Intrauterine Balloon tamponade and another perinatal network that did not in postpartum hemorrhage management. METHODS This population-based retrospective cohort study included all women (72,529) delivering between 2011 and 2012 in the 19 maternity units in two French perinatal networks: a pilot (in which Balloon tamponade was used) and a control network. Outcomes were assessed based on discharge abstract data from the national French medical information system. General and obstetric characteristics were included in two separate multivariate logistic models according to the mode of delivery (vaginal and cesarean) to estimate the independent association of the network with invasive procedures. RESULTS Invasive procedures (pelvic vessel ligation, arterial embolization, hysterectomy) were used in 298 women and in 4.1 per 1,000 deliveries (95% CI 3.7-4.6). The proportion of women with at least one invasive procedure was significantly lower in the pilot network (3.0/1,000 vs 5.1/1,000, P<.01). Among women who delivered vaginally, the use of arterial embolization was also significantly lower in the pilot than the control network (0.2/1,000 vs 3.7/1,000, P<.01) as it was for those who delivered by cesarean (1.3/1,000 vs 5.7/1,000, P<.01). After controlling for potential confounding factors, the risk of an invasive procedure among women who delivered vaginally remained significantly lower in the pilot network (adjusted odds ratio [OR] 0.14, 95% CI 0.08-0.27), but not for women who delivered by cesarean (adjusted OR 1.19, 95% CI 0.87-1.61). CONCLUSION The use of Intrauterine Balloon tamponade in routine clinical practice was associated with a significantly lower use of invasive procedures for hemorrhage control among women undergoing vaginal delivery.
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Intrauterine Balloon tamponade for management of severe postpartum haemorrhage in a perinatal network: a prospective cohort study
BJOG: An International Journal of Obstetrics and Gynaecology, 2017Co-Authors: Mathilde Revert, Jonathan Cottenet, Catherine Quantin, Pierre Raynal, E. Cibot, Patrick RozenbergAbstract:Objective: To evaluate the effectiveness of Intrauterine Balloon tamponade (IUBT) for management of severe postpartum haemorrhage (PPH). To identify the factors predicting IUBT failure. Design: Prospective cohort study. Setting: Ten maternity units in a perinatal network. Population: Women treated by IUBT from July 2010 to March 2013. Methods: The global IUBT success rate was expressed as the number of women with severe PPH who were successfully treated by IUBT divided by the total number treated by IUBT. IUBT failure was defined as the need for arterial embolisation or surgery. Logistic regression analysis was used to estimate factors predicting IUBT failure. Main outcome measures: Global IUBT success rate. Factors associated with IUBT failure. Results: Intrauterine Balloon tamponade was attempted in 226 women: 171 after vaginal delivery (VD) (75.7%) and 55 during or after caesarean delivery (CD) (24.3%). The global success rate was 83.2% (188/226) and was significantly higher after VD (152/171, 88.9%) than CD (36/55, 65.5%, P < 0.01). The percentage of CD was significantly higher in the failure group (50.0 versus 19.1%, P < 0.01), as was mean (SD) estimated blood loss before IUBT: 1508 ± 675 ml versus 1064 ± 476, P < 0.01. Coagulopathy was significantly more frequent in the failure group (50.0% versus 17.2%, P < 0.01). CD [Odds ratio (OR) 3.5; 95% CI 1.6–7.6], estimated blood loss before IUBT (OR 3.2; 95% CI 1.5–6.8) and coagulopathy (OR 5.6; 95% CI 2.5–13.0) were predictive of IUBT failure. Conclusion: Intrauterine Balloon tamponade is an effective method for treating severe PPH. Early Balloon deployment before the development of coagulopathy increases its success rate. Tweetable abstract: Intrauterine Balloon tamponade is effective for achieving haemostasis in intractable postpartum haemorrhages.
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162: Evaluation of the efficacy of the Intrauterine Balloon tamponade as a second-line procedure in the management of severe postpartum hemorrhage within a perinatal network
American Journal of Obstetrics and Gynecology, 2013Co-Authors: Thomas Popowski, Pierre Raynal, Patrick RozenbergAbstract:tamponade as a second-line procedure in the management of severe postpartum hemorrhage within a perinatal network Thomas Popowski, Pierre Raynal, Patrick Rozenberg Poissy Saint-Germain Hospital, Versailles Saint-Quentin-en-Yvelines University, research unit EA 7285, Department of Obstetrics and Gynecology, Poissy, France, Mignot Hospital, Department of Obstetrics and Gynecology, Le Chesnay, France OBJECTIVE: To evaluate the efficacy of the Intrauterine Balloon tamponade (IUBT) as the initial second-line procedure when medical management fails in the management of severe postpartum hemorrhage (PPH). STUDY DESIGN: We carried out a prospective cohort study within a perinatal network comprising 10 perinatal units managing around 20,000 deliveries per annum. The protocol for management of PPH followed the French national guidelines. In April 2008, the IUBT using Bakri Balloon was introduce in the tertiary referral university hospital and the protocol was modified to require that an IUBT test be used before any invasive procedure in PPH unresponsive to prostaglandin. The modified protocol was progressively extended to the 9 other maternities. The tamponade test was considered successful if control was achieved following inflation of the Balloon. RESULTS: Between April 2008 and June 2012, 166 IUBT tests were performed. The mean maternal age was 30.4 (SD 5.2) years, the mean gestational age 39.1 (SD 2.5) WG, and the mean parity 1.1 (SD 1.2). Nineteen (11.5%) patients had a previous history of cesarean section (CS), 25 (15.1%) a previous history of PPH, 14 (8.4%) were multiple pregnancies, and 8 (4.8%) presented a placenta previa. Among the 166 patients, the mean blood loss was 1484 (SD 602) mL, 105 (63.3%) patients had blood transfusion with a mean of 3.9 (SD 2.8) units of packed red blood cells. Among the 122 patients delivered vaginally, the IUBT failed in 17 (13.9%) patients leading to 11 embolizations, 2 conservative surgical procedures, and 4 hysterectomies. Among the 44 patients delivered by CS, the IUBT failed in 10 (22.7%) patients leading to 5 embolizations, 3 conservative surgical procedures, and 2 hysterectomies. The global success rate of the IUBT was 83.7%. CONCLUSION: In the setting of PPH unresponsive to medical management, IUBT should be used as the initial second-line procedure.
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A Randomized Controlled Trial to Test the Effectiveness of Intrautetine Balloon Tamponade with Condom Catheter in Severe Postpartum Hemorrhage Management: A Feasibility Study in Benin
Journal of Women's Health Care, 2013Co-Authors: Julie Tort, Patrick Rozenberg, Hounkpatin B, Popowski T, Mamadou Traoré, Cécile Bodin, Perrin R, Alexandre DumontAbstract:Background: In low-resource countries, Postpartum Hemorrhage (PPH) is the leading cause of maternal mortality. Thus, it is important to identify procedures that are adapted to their situation. The Intrauterine Balloon tamponade was recently incorporated into the strategy to manage uterine atony. There are many types of tamponades. Among them, the condom catheter seems to be an efficient and economic intervention for the treatment of PPH in lowresource countries. However, its effectiveness has not yet undergone rigorous evaluation. Our objective is to assess the feasibility of a Randomized Control Trial (RCT) that will test the efficacy of the Intrauterine Balloon tamponade with condom catheter in low-resource countries. Methods: We carried out a pilot study of an individual randomized parallel-group controlled trial (CONDOM-PPH Trial) in three health facilities representing different levels in the health pyramid in Cotonou, Benin. Women presenting postpartum hemorrhage refractory to first-line treatments after a vaginal delivery were included. The main outcomes measures were the feasibility of recruitment, acceptability of the condom catheter by clinicians, its impact on organizing care, and its tolerance among women. Data collected from interviews with clinicians, field observations, a standardized questionnaire on the women’s characteristics and their treatment at inclusion, and a weekly data-collection system on facility activities and inclusion monitoring. Analysis was performed using quantitative and qualitative methods. Results: The condom catheter is generally well accepted by clinicians. Its assembly was considered fast and easy. No side effects were reported. Over a four-month period, ten women were randomized: five in the intervention group (condom catheter + misoprostol) and five in the control group (only misoprostol). The recruitment rate was 0.3% of vaginal deliveries. Conclusion: By ensuring that measures are taken to increase staff motivation, implementing a RCT is feasible in this context despite a few technical difficulties related to randomization in an emergency situation.
Shay Porat - One of the best experts on this subject based on the ideXlab platform.
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Intrauterine Balloon tamponade as a treatment for immune thrombocytopenic purpura induced severe uterine bleeding
Fertility and Sterility, 2010Co-Authors: Yaron Hamani, Yossef Kalish, Inbar Benshachar, Shay PoratAbstract:Objective To report our experience of applying Balloon tamponade in the treatment of Intrauterine bleeding in two patients with immune thrombocytopenic purpura (ITP). Immune thrombocytopenic purpura is a well-known hematologic autoimmune disease. The uterus may be a major site of bleeding in patients with ITP. Halting bleeding is imperative to reduce blood loss and platelet consumption and to allow medical treatment to increase platelet count. Balloon tamponade has been described as an effective method to control bleeding in a variety of clinical situations; it is an effective and accessible modality, requiring no analgesia or anesthesia, and helps facilitate continuous monitoring of uterine bleeding. Design Report of two cases. Setting Obstetrics and gynecology department in a tertiary care center in Jerusalem, Israel. Patient(s) Two patients with ITP with severe uterine bleeding refractory to treatment with estrogen and IV IgG. Intervention(s) Intrauterine Balloon tamponade. Main Outcome Measure(s) Cessation of uterine bleeding, appearance of complications. Result(s) Insertion of Balloon tamponade successfully controlled bleeding in both cases. The patient in case 1 subsequently had persistent hypomenorrhea. The patient in case 2 had abdominal pain and suspected pelvic inflammation. Conclusion(s) Our presented cases demonstrate that uterine bleeding can be controlled successfully in patients with ITP with an Intrauterine Balloon. This novel application raises many technical issues, such as the appropriate filling pressures and duration of treatment. Possible risks, such as endometrial injury, still remain to be resolved and mandate future clinical research.
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Intrauterine Balloon tamponade as a treatment for immune thrombocytopenic purpura–induced severe uterine bleeding
Fertility and sterility, 2010Co-Authors: Yaron Hamani, Inbar Ben-shachar, Yossef Kalish, Shay PoratAbstract:Objective To report our experience of applying Balloon tamponade in the treatment of Intrauterine bleeding in two patients with immune thrombocytopenic purpura (ITP). Immune thrombocytopenic purpura is a well-known hematologic autoimmune disease. The uterus may be a major site of bleeding in patients with ITP. Halting bleeding is imperative to reduce blood loss and platelet consumption and to allow medical treatment to increase platelet count. Balloon tamponade has been described as an effective method to control bleeding in a variety of clinical situations; it is an effective and accessible modality, requiring no analgesia or anesthesia, and helps facilitate continuous monitoring of uterine bleeding. Design Report of two cases. Setting Obstetrics and gynecology department in a tertiary care center in Jerusalem, Israel. Patient(s) Two patients with ITP with severe uterine bleeding refractory to treatment with estrogen and IV IgG. Intervention(s) Intrauterine Balloon tamponade. Main Outcome Measure(s) Cessation of uterine bleeding, appearance of complications. Result(s) Insertion of Balloon tamponade successfully controlled bleeding in both cases. The patient in case 1 subsequently had persistent hypomenorrhea. The patient in case 2 had abdominal pain and suspected pelvic inflammation. Conclusion(s) Our presented cases demonstrate that uterine bleeding can be controlled successfully in patients with ITP with an Intrauterine Balloon. This novel application raises many technical issues, such as the appropriate filling pressures and duration of treatment. Possible risks, such as endometrial injury, still remain to be resolved and mandate future clinical research.
Yaron Hamani - One of the best experts on this subject based on the ideXlab platform.
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Intrauterine Balloon tamponade as a treatment for immune thrombocytopenic purpura induced severe uterine bleeding
Fertility and Sterility, 2010Co-Authors: Yaron Hamani, Yossef Kalish, Inbar Benshachar, Shay PoratAbstract:Objective To report our experience of applying Balloon tamponade in the treatment of Intrauterine bleeding in two patients with immune thrombocytopenic purpura (ITP). Immune thrombocytopenic purpura is a well-known hematologic autoimmune disease. The uterus may be a major site of bleeding in patients with ITP. Halting bleeding is imperative to reduce blood loss and platelet consumption and to allow medical treatment to increase platelet count. Balloon tamponade has been described as an effective method to control bleeding in a variety of clinical situations; it is an effective and accessible modality, requiring no analgesia or anesthesia, and helps facilitate continuous monitoring of uterine bleeding. Design Report of two cases. Setting Obstetrics and gynecology department in a tertiary care center in Jerusalem, Israel. Patient(s) Two patients with ITP with severe uterine bleeding refractory to treatment with estrogen and IV IgG. Intervention(s) Intrauterine Balloon tamponade. Main Outcome Measure(s) Cessation of uterine bleeding, appearance of complications. Result(s) Insertion of Balloon tamponade successfully controlled bleeding in both cases. The patient in case 1 subsequently had persistent hypomenorrhea. The patient in case 2 had abdominal pain and suspected pelvic inflammation. Conclusion(s) Our presented cases demonstrate that uterine bleeding can be controlled successfully in patients with ITP with an Intrauterine Balloon. This novel application raises many technical issues, such as the appropriate filling pressures and duration of treatment. Possible risks, such as endometrial injury, still remain to be resolved and mandate future clinical research.
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Intrauterine Balloon tamponade as a treatment for immune thrombocytopenic purpura–induced severe uterine bleeding
Fertility and sterility, 2010Co-Authors: Yaron Hamani, Inbar Ben-shachar, Yossef Kalish, Shay PoratAbstract:Objective To report our experience of applying Balloon tamponade in the treatment of Intrauterine bleeding in two patients with immune thrombocytopenic purpura (ITP). Immune thrombocytopenic purpura is a well-known hematologic autoimmune disease. The uterus may be a major site of bleeding in patients with ITP. Halting bleeding is imperative to reduce blood loss and platelet consumption and to allow medical treatment to increase platelet count. Balloon tamponade has been described as an effective method to control bleeding in a variety of clinical situations; it is an effective and accessible modality, requiring no analgesia or anesthesia, and helps facilitate continuous monitoring of uterine bleeding. Design Report of two cases. Setting Obstetrics and gynecology department in a tertiary care center in Jerusalem, Israel. Patient(s) Two patients with ITP with severe uterine bleeding refractory to treatment with estrogen and IV IgG. Intervention(s) Intrauterine Balloon tamponade. Main Outcome Measure(s) Cessation of uterine bleeding, appearance of complications. Result(s) Insertion of Balloon tamponade successfully controlled bleeding in both cases. The patient in case 1 subsequently had persistent hypomenorrhea. The patient in case 2 had abdominal pain and suspected pelvic inflammation. Conclusion(s) Our presented cases demonstrate that uterine bleeding can be controlled successfully in patients with ITP with an Intrauterine Balloon. This novel application raises many technical issues, such as the appropriate filling pressures and duration of treatment. Possible risks, such as endometrial injury, still remain to be resolved and mandate future clinical research.
Catherine Quantin - One of the best experts on this subject based on the ideXlab platform.
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Intrauterine Balloon Tamponade for Severe Postpartum Hemorrhage.
Obstetrics and gynecology, 2018Co-Authors: Mathilde Revert, Patrick Rozenberg, Jonathan Cottenet, Catherine QuantinAbstract:OBJECTIVE To compare the rates of invasive procedures (surgical or vascular) for hemorrhage control between a perinatal network that routinely used Intrauterine Balloon tamponade and another perinatal network that did not in postpartum hemorrhage management. METHODS This population-based retrospective cohort study included all women (72,529) delivering between 2011 and 2012 in the 19 maternity units in two French perinatal networks: a pilot (in which Balloon tamponade was used) and a control network. Outcomes were assessed based on discharge abstract data from the national French medical information system. General and obstetric characteristics were included in two separate multivariate logistic models according to the mode of delivery (vaginal and cesarean) to estimate the independent association of the network with invasive procedures. RESULTS Invasive procedures (pelvic vessel ligation, arterial embolization, hysterectomy) were used in 298 women and in 4.1 per 1,000 deliveries (95% CI 3.7-4.6). The proportion of women with at least one invasive procedure was significantly lower in the pilot network (3.0/1,000 vs 5.1/1,000, P
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Intrauterine Balloon tamponade for severe postpartum hemorrhage
Obstetrics & Gynecology, 2017Co-Authors: Mathilde Revert, Patrick Rozenberg, Jonathan Cottenet, Catherine QuantinAbstract:OBJECTIVE To compare the rates of invasive procedures (surgical or vascular) for hemorrhage control between a perinatal network that routinely used Intrauterine Balloon tamponade and another perinatal network that did not in postpartum hemorrhage management. METHODS This population-based retrospective cohort study included all women (72,529) delivering between 2011 and 2012 in the 19 maternity units in two French perinatal networks: a pilot (in which Balloon tamponade was used) and a control network. Outcomes were assessed based on discharge abstract data from the national French medical information system. General and obstetric characteristics were included in two separate multivariate logistic models according to the mode of delivery (vaginal and cesarean) to estimate the independent association of the network with invasive procedures. RESULTS Invasive procedures (pelvic vessel ligation, arterial embolization, hysterectomy) were used in 298 women and in 4.1 per 1,000 deliveries (95% CI 3.7-4.6). The proportion of women with at least one invasive procedure was significantly lower in the pilot network (3.0/1,000 vs 5.1/1,000, P<.01). Among women who delivered vaginally, the use of arterial embolization was also significantly lower in the pilot than the control network (0.2/1,000 vs 3.7/1,000, P<.01) as it was for those who delivered by cesarean (1.3/1,000 vs 5.7/1,000, P<.01). After controlling for potential confounding factors, the risk of an invasive procedure among women who delivered vaginally remained significantly lower in the pilot network (adjusted odds ratio [OR] 0.14, 95% CI 0.08-0.27), but not for women who delivered by cesarean (adjusted OR 1.19, 95% CI 0.87-1.61). CONCLUSION The use of Intrauterine Balloon tamponade in routine clinical practice was associated with a significantly lower use of invasive procedures for hemorrhage control among women undergoing vaginal delivery.
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Intrauterine Balloon tamponade for management of severe postpartum haemorrhage in a perinatal network: a prospective cohort study
BJOG: An International Journal of Obstetrics and Gynaecology, 2017Co-Authors: Mathilde Revert, Jonathan Cottenet, Catherine Quantin, Pierre Raynal, E. Cibot, Patrick RozenbergAbstract:Objective: To evaluate the effectiveness of Intrauterine Balloon tamponade (IUBT) for management of severe postpartum haemorrhage (PPH). To identify the factors predicting IUBT failure. Design: Prospective cohort study. Setting: Ten maternity units in a perinatal network. Population: Women treated by IUBT from July 2010 to March 2013. Methods: The global IUBT success rate was expressed as the number of women with severe PPH who were successfully treated by IUBT divided by the total number treated by IUBT. IUBT failure was defined as the need for arterial embolisation or surgery. Logistic regression analysis was used to estimate factors predicting IUBT failure. Main outcome measures: Global IUBT success rate. Factors associated with IUBT failure. Results: Intrauterine Balloon tamponade was attempted in 226 women: 171 after vaginal delivery (VD) (75.7%) and 55 during or after caesarean delivery (CD) (24.3%). The global success rate was 83.2% (188/226) and was significantly higher after VD (152/171, 88.9%) than CD (36/55, 65.5%, P < 0.01). The percentage of CD was significantly higher in the failure group (50.0 versus 19.1%, P < 0.01), as was mean (SD) estimated blood loss before IUBT: 1508 ± 675 ml versus 1064 ± 476, P < 0.01. Coagulopathy was significantly more frequent in the failure group (50.0% versus 17.2%, P < 0.01). CD [Odds ratio (OR) 3.5; 95% CI 1.6–7.6], estimated blood loss before IUBT (OR 3.2; 95% CI 1.5–6.8) and coagulopathy (OR 5.6; 95% CI 2.5–13.0) were predictive of IUBT failure. Conclusion: Intrauterine Balloon tamponade is an effective method for treating severe PPH. Early Balloon deployment before the development of coagulopathy increases its success rate. Tweetable abstract: Intrauterine Balloon tamponade is effective for achieving haemostasis in intractable postpartum haemorrhages.
Choi Wah Kong - One of the best experts on this subject based on the ideXlab platform.
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Menstrual and reproductive outcomes after use of Balloon tamponade for severe postpartum hemorrhage.
BMC pregnancy and childbirth, 2018Co-Authors: Choi Wah KongAbstract:The use of Intrauterine Balloon tamponade to manage postpartum hemorrhage is increasing. However, there is lack of studies on the menstrual and reproductive outcomes after such treatment. The purpose of this study is to explore the menstrual and reproductive outcomes for patients who had been managed by Intrauterine Balloon tamponade for severe postpartum hemorrhage in her index pregnancy. All patients who had delivered in United Christian Hospital from January 2011 to June 2016 with severe postpartum hemorrhage (PPH) (blood loss> = 1 L) were identified by the labour ward delivery registry and a comprehensive obstetric database. Patients who had Intrauterine Balloon tamponade inserted were compared with those managed solely by uterotonic agents as controls. Patients who had hysterectomy or additional procedures performed, such as compression sutures or uterine artery embolization were excluded from both groups. A questionnaire on menses, fertility and reproductive outcomes was mailed to both groups of patients. Those that had not replied within 4 weeks would receive a telephone survey. A total of 39 patients in the Balloon tamponade group and 161 patients in the control group were recruited, which represented 87.0% of all eligible patients within the study period. The median follow up period was 45 months. All patients in the Balloon tamponade group had return of menses after delivery. The majority of the patients (87.2%) in the Balloon tamponade group had normal menstrual patterns in the 12 months after the index delivery as well as in the most recent 12 months. After excluding the patients with contraception, the subsequent pregnancy rate was 42.9% (9/21) in the Balloon tamponade group compared to 45.9% (28/61) in the control group (p = 0.81). Among the 9 subsequent pregnancies in the Balloon tamponade group, there were two miscarriages, one scar pregnancy, one induced abortion, while the remaining five were normal pregnancies with full term deliveries without Intrauterine growth restriction. The majority of patients replied that they were satisfied with using Bakri Balloon for PPH management in their index pregnancy. Intrauterine Balloon tamponade for the management of severe PPH appeared to pose little adverse effects on subsequent menstrual and reproductive function.
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Menstrual and reproductive outcomes after use of Balloon tamponade for severe postpartum hemorrhage
BMC Pregnancy and Childbirth, 2018Co-Authors: Choi Wah KongAbstract:Background The use of Intrauterine Balloon tamponade to manage postpartum hemorrhage is increasing. However, there is lack of studies on the menstrual and reproductive outcomes after such treatment. The purpose of this study is to explore the menstrual and reproductive outcomes for patients who had been managed by Intrauterine Balloon tamponade for severe postpartum hemorrhage in her index pregnancy. Methods All patients who had delivered in United Christian Hospital from January 2011 to June 2016 with severe postpartum hemorrhage (PPH) (blood loss> = 1 L) were identified by the labour ward delivery registry and a comprehensive obstetric database. Patients who had Intrauterine Balloon tamponade inserted were compared with those managed solely by uterotonic agents as controls. Patients who had hysterectomy or additional procedures performed, such as compression sutures or uterine artery embolization were excluded from both groups. A questionnaire on menses, fertility and reproductive outcomes was mailed to both groups of patients. Those that had not replied within 4 weeks would receive a telephone survey. Results A total of 39 patients in the Balloon tamponade group and 161 patients in the control group were recruited, which represented 87.0% of all eligible patients within the study period. The median follow up period was 45 months. All patients in the Balloon tamponade group had return of menses after delivery. The majority of the patients (87.2%) in the Balloon tamponade group had normal menstrual patterns in the 12 months after the index delivery as well as in the most recent 12 months. After excluding the patients with contraception, the subsequent pregnancy rate was 42.9% (9/21) in the Balloon tamponade group compared to 45.9% (28/61) in the control group ( p = 0.81). Among the 9 subsequent pregnancies in the Balloon tamponade group, there were two miscarriages, one scar pregnancy, one induced abortion, while the remaining five were normal pregnancies with full term deliveries without Intrauterine growth restriction. The majority of patients replied that they were satisfied with using Bakri Balloon for PPH management in their index pregnancy. Conclusions Intrauterine Balloon tamponade for the management of severe PPH appeared to pose little adverse effects on subsequent menstrual and reproductive function.
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Prognostic factors for the use of Intrauterine Balloon tamponade in the management of severe postpartum hemorrhage.
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2018Co-Authors: Choi Wah KongAbstract: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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Intraluminal pressure of uterine Balloon tamponade in the management of severe post-partum hemorrhage.
The journal of obstetrics and gynaecology research, 2018Co-Authors: Choi Wah KongAbstract: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.