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Effectiveness of uterine tamponade devices for refractory postpartum haemorrhage after vaginal birth: a systematic review.
- Source :
-
BJOG : an international journal of obstetrics and gynaecology [BJOG] 2021 Oct; Vol. 128 (11), pp. 1732-1743. Date of Electronic Publication: 2021 Jul 19. - Publication Year :
- 2021
-
Abstract
- Objectives: To evaluate uterine tamponade devices' effectiveness for atonic refractory postpartum haemorrhage (PPH) after vaginal birth and the effect of including them in institutional protocols.<br />Search Strategy: PubMed, EMBASE, CINAHL, LILACS, POPLINE, from inception to January 2021.<br />Study Selection: Randomised and non-randomised comparative studies.<br />Outcomes: Composite outcome including surgical interventions (artery ligations, compressive sutures or hysterectomy) or maternal death, and hysterectomy.<br />Results: All included studies were at high risk of bias. The certainty of the evidence was rated as very low to low. One randomised study measured the effect of the condom-catheter balloon compared with standard care and found unclear results for the composite outcome (relative risk [RR] 2.33, 95% CI 0.76-7.14) and hysterectomy (RR 4.14, 95% CI 0.48-35.93). Three comparative studies assessed the effect of including uterine balloon tamponade in institutional protocols. A stepped wedge cluster randomised controlled trial suggested an increase in the composite outcome (RR 4.08, 95% CI 1.07-15.58) and unclear results for hysterectomy (RR 4.38, 95% CI 0.47-41.09) with the use of the condom-catheter or surgical glove balloon. One non-randomised study showed unclear effects on the composite outcome (RR 0.33, 95% CI 0.11-1.03) and hysterectomy (RR 0.49, 95% CI 0.04-5.38) after the inclusion of the Bakri balloon. The second non-randomised study found unclear effects on the composite outcome (RR 0.95, 95% CI 0.32-2.81) and hysterectomy (RR 1.84, 95% CI 0.44-7.69) after the inclusion of Ebb or Bakri balloon.<br />Conclusions: The effect of uterine tamponade devices for the management of atonic refractory PPH after vaginal delivery is unclear, as is the role of the type of device and the setting.<br />Tweetable Abstract: Unclear effects of uterine tamponade devices and their inclusion in institutional protocols for atonic refractory PPH after vaginal delivery.<br /> (© 2021 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)
- Subjects :
- Adult
Delivery, Obstetric methods
Female
Hemostatic Techniques mortality
Humans
Hysterectomy mortality
Hysterectomy statistics & numerical data
Ligation instrumentation
Maternal Mortality
Postpartum Hemorrhage mortality
Pregnancy
Treatment Outcome
Uterine Artery surgery
Uterine Artery Embolization instrumentation
Uterine Artery Embolization mortality
Uterine Balloon Tamponade mortality
Vagina
Delivery, Obstetric adverse effects
Hemostatic Techniques instrumentation
Postpartum Hemorrhage therapy
Uterine Balloon Tamponade instrumentation
Subjects
Details
- Language :
- English
- ISSN :
- 1471-0528
- Volume :
- 128
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- BJOG : an international journal of obstetrics and gynaecology
- Publication Type :
- Academic Journal
- Accession number :
- 34165867
- Full Text :
- https://doi.org/10.1111/1471-0528.16819