Dabelea Victor, Schultze Peter M, McDuffie Robert S
Department of Obstetrics and Gynecology, Exempla Saint Joseph Hospital, Denver, Colorado 80205, USA.
Am J Perinatol. 2007 Jun;24(6):359-64. doi: 10.1055/s-2007-984402. Epub 2007 Jun 13.
This article reviews our experience with the use of intrauterine tamponade with balloon catheters in the management of severe postpartum hemorrhage. This is a case series report of 23 patients with postpartum hemorrhage unresponsive to medical therapy managed with intrauterine balloon tamponade. We identified these patients by International Classification of Diseases (ICD-9) codes and by reviewing labor and delivery logs. Balloon tamponade was attempted in 23 patients. When properly placed, catheters controlled postpartum hemorrhage in 18 of 20 cases (90%). In two cases, hysterectomy was required despite successful placement of the catheter. For hemorrhage due to uterine atony, our success rate was 100% (11/11 cases). In three cases, technical difficulties led to placement failure. For bleeding due to retained placenta, our success rate was 80% (4/5; failure with placenta percreta). Vaginal bleeding was stopped with the catheter in two of three cases of amniotic fluid embolus and in one case after dilation and curettage for postpartum septic shock. Thus balloon tamponade is an effective adjunct in the treatment of severe postpartum hemorrhage, especially when due to uterine atony when medical therapy fails.
本文回顾了我们使用球囊导管宫腔填塞治疗严重产后出血的经验。这是一篇关于23例对药物治疗无效的产后出血患者采用宫腔球囊填塞治疗的病例系列报告。我们通过国际疾病分类（ICD - 9）编码以及查阅分娩记录来确定这些患者。对23例患者尝试进行球囊填塞。放置正确时，20例中有18例（90%）导管控制住了产后出血。有2例患者尽管导管放置成功，但仍需行子宫切除术。对于子宫收缩乏力导致的出血，我们的成功率为100%（11/11例）。有3例因技术困难导致放置失败。对于胎盘残留引起的出血，我们的成功率为80%（4/5；穿透性胎盘植入失败）。3例羊水栓塞患者中有2例以及1例因产后感染性休克行刮宫术后的阴道出血通过导管得以止住。因此，球囊填塞是治疗严重产后出血的一种有效辅助方法，尤其是在药物治疗无效且由子宫收缩乏力引起的产后出血时。
