Son Moeun, Einerson Brett D, Schneider Patrick, Fields Ian C, Grobman William A, Miller Emily S
Division of Maternal-Fetal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah.
Am J Perinatol. 2017 Jan;34(2):164-168. doi: 10.1055/s-0036-1585084. Epub 2016 Jul 1.
Determine whether the indication for intrauterine balloon tamponade (IUBT) is associated with failure rates. Cohort study of women who underwent IUBT for postpartum hemorrhage (PPH) from 2007 to 2014. The indication was categorized as uterine atony or placental-site bleeding. Primary outcome was IUBT failure, defined as the need for uterine artery embolization or hysterectomy. Secondary outcomes were estimated blood loss (EBL) after balloon placement, transfusion of red blood cells (RBC), transfusion of fresh frozen plasma (FFP) and/or cryoprecipitate, and intensive care unit (ICU) admission. 306 women underwent IUBT: 241 (78.8%) for uterine atony and 65 (21.2%) for placental site bleeding. Overall, 67 (21.9%) women experienced IUBT failure. The frequency of failure was similar in those with uterine atony compared with those with placental-site bleeding (21.2 vs 24.6%, = 0.55). This finding persisted after adjusting for potential confounders (aOR, 0.97; 95% CI, 0.48-1.99). Median EBL after balloon placement (190 [interquartile range, 93-375] vs 195 [interquartile range, 103-500] mL, = 0.46), and frequencies of RBC transfusion (62.7 vs 66.2%, = 0.60), FFP and/or cryoprecipitate transfusion (25.3 vs 33.8%, = 0.17), and ICU admission (12.4 vs 16.9%, = 0.35) were also similar. IUBT was similarly effective for managing PPH from uterine atony or placental-site bleeding.
确定宫腔球囊填塞术（IUBT）的适应症是否与失败率相关。对2007年至2014年因产后出血（PPH）接受IUBT的女性进行队列研究。适应症分为宫缩乏力或胎盘部位出血。主要结局为IUBT失败，定义为需要进行子宫动脉栓塞或子宫切除术。次要结局为球囊放置后的估计失血量（EBL）、红细胞（RBC）输血、新鲜冰冻血浆（FFP）和/或冷沉淀输血以及重症监护病房（ICU）入院情况。306名女性接受了IUBT：241名（78.8%）因宫缩乏力，65名（21.2%）因胎盘部位出血。总体而言，67名（21.9%）女性IUBT失败。宫缩乏力患者与胎盘部位出血患者的失败频率相似（21.2%对24.6%，P = 0.55）。在调整潜在混杂因素后，这一发现仍然存在（校正优势比，0.97；95%置信区间，0.48 - 1.99）。球囊放置后的中位EBL（190[四分位间距，93 - 375]对195[四分位间距，103 - 500]mL，P = 0.46），以及RBC输血频率（62.7%对66.2%，P = 0.60）、FFP和/或冷沉淀输血频率（25.3%对33.8%，P = 0.17）以及ICU入院频率（12.4%对16.9%，P = 0.35）也相似。IUBT在处理宫缩乏力或胎盘部位出血引起的PPH方面同样有效。
