Stop postpartum bleeding with balloon tamponade
Even today, peri- or postpartum bleeding (PPH = postpartum hemorrhage) is one of the most dangerous complications around childbirth due to the often high blood loss. PPH occur in about 1 in 1,000 births. Postpartum bleeding is one of the most common causes of maternal death, accounting for up to 25%.
Bleeding is caused by placenta residues in the uterus or placenta implantation disorders such as placenta accreta (the placenta grows into the uterine tissue). The front runner among the causes of PPH is uterine atony with approx. 75%. Postpartum uterine atony with gushing massive bleeding from the flaccid uterus affects 2 – 8% of all women in labor.
Provide compression for PPH
It is well known that most bleeding is due to compression. The body does this in a physiological way after a birth through the contraction of the uterus. If this does not happen, this contraction can be triggered by administering oxytocin by means of drugs. Compression can also be achieved mechanically using the Credé or Hamilton handle. However, this is only possible for a short time. With the balloon tamponade of the uterine cavity, compression can be maintained over a longer period of time. As an alternative or if this method fails, only surgical intervention, for example embolization of the uterine arteries, or hysterectomy as a last resort.
In the case of balloon tamponade, a balloon is inserted vaginally – in the case of caesarean section, also abdominally – into the uterine cavity. The balloon is filled with 70 to 500 ml of body temperature NaCl 0.9% and can then be left for up to 24 hours. After a vaginal birth, the balloon can be prevented from dislodging with a vaginal tamponade.
UTB success rate 86%
Obstetricians from Boston (Massachusetts, USA) wanted to know how effective this balloon tamponade is for PPH, regardless of the cause of the bleeding. In a meta-analysis of 91 studies, they evaluated the data of 4,729 women with PPH who had been treated with uterine balloon tamponade (UTB). Overall, the success of the UTB was 85.9% (95% CI: 83.9 – 87.9%). Depending on the cause of the bleeding, UTB was most successful in uterine atony with 87.1% (84.1 – 89.9%); and placenta previa with 86.8% (CI 82.3 – 90.6%).
The UTB worked less well with retention of the unripe fruit (76.8%, CI 65.3-86.5%) and with complications from the placenta accreta spectrum: here the success rate was 66.7% (CI 49, 4 – 81.9%).
UTB a little better with vaginal delivery
The US researchers also looked at the differences in the delivery process: UTB was somewhat more successful in vaginal delivery with 87.1% compared to caesarean delivery with 81.7%.
UTB reduced the use of arterial embolization: the relative risk was 0.29 (95% CI: 0.14-0.63).
Low complication rate
The complication rate across all studies was 6.5%. The following complications were rated:
- Fever or infection (6.5%)
- Endometritis (2.3%)
- Cervical tear (1.7%)
- Tear wound in the lower part of the vagina (4.8%)
- Incisional rupture of the uterus (1.9%)
- Uterine perforation (2.0%)
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