Uterine balloon tamponade for managing postpartum hemorrhage

The present study assessed the efficacy, effectiveness, and safety of uterine balloon tamponade in managing postpartum hemorrhage.

It searched electronic databases and bibliographies, for studies and trials that reported the efficacy, effectiveness, and/or safety of uterine balloon tamponade in females with postpartum hemorrhage. The study looked for the success rate of uterine balloon tamponade for treating postpartum hemorrhage.

The study observed-

• Ninety-one eligible studies, including 4729 women (6 randomized trials, 1 cluster randomized trial, 15 nonrandomized studies, and 69 case series). 
• 85.9% overall pooled uterine balloon tamponade success rate.
• Uterine atony (87.1%) and placenta previa (86.8%) corresponded to the highest success rates, while placenta accreta spectrum (66.7%) and residual products of conception (76.8%) corresponded to the lowest. 
• Lower uterine balloon tamponade success rate in cesarean deliveries (81.7%) than vaginal deliveries (87.0%).
• Meta-analysis of 2 randomized trials comparing uterine balloon tamponade vs. no uterine balloon tamponade in postpartum hemorrhage because of uterine atony after vaginal delivery revealed no marked differences between the study groups regarding risk of surgical interventions or maternal death. 
• A meta-analysis of 2 nonrandomized before-and-after studies revealed that employing uterine balloon tamponade in protocols for managing severe postpartum hemorrhage reduced the use of arterial embolization.
• A nonrandomized cluster study reported that employing invasive procedures was significantly lower in the perinatal network that routinely used uterine balloon tamponade than that which did not use uterine balloon tamponade. 
• A cluster randomized trial conveyed that the frequency of postpartum hemorrhage–related invasive procedures and/or maternal death was particularly higher after uterine balloon tamponade introduction than before.
• Overall, low frequency of complications following uterine balloon tamponade use.

This study shows that Uterine balloon tamponade has a high success rate and is safe for managing severe postpartum hemorrhage. The evidence on uterine balloon tamponade efficacy and effectiveness from randomized and nonrandomized studies is discordant, with experimental studies suggesting no beneficial effect, opposing the observational studies. Further research must determine the most effective programmatic and healthcare delivery strategies for uterine balloon tamponade introduction and use.

Suarez S, Conde-Agudelo A, Borovac-Pinheiro A, et al. Uterine balloon tamponade for the treatment of postpartum hemorrhage: a systematic review and meta-analysis. American Journal of Obstetrics and Gynecology. 2020;222(4): 293.e1-293.e52. https://doi.org/10.1016/j.ajog.2019.11.1287.