Department of Obstetrics and Gynecology, Centre Hospitalier Départemental, La Roche sur Yon, France.
Réseau Sécurité Naissance des Pays de la Loire, Nantes, France.
PLoS One. 2018 Oct 26;13(10):e0206663. doi: 10.1371/journal.pone.0206663. eCollection 2018.
To identify the predictors of intrauterine balloon tamponade (IUBT) failure for persistent postpartum hemorrhage (PPH) after vaginal delivery.
Retrospective case-series in five maternity units in a perinatal network.
All women who underwent IUBT for persistent PPH after vaginal delivery from January 2011 to December 2015 in these hospitals.
All maternity apply the same management policy for PPH. IUBT, using a Bakri balloon, was used as a second line therapy for persistent PPH after failure of bimanual uterine massage and uterotonics to stop bleeding after vaginal delivery. Women who required another second line therapy (embolization or surgical procedures) to stop bleeding after IUBT were defined as cases, and women whom IUBT stopped bleeding were defined as control group. We determined independent predictors for failed IUBT using multiple regression and adjusting for demographics with adjusted odds ratios (aORs) and 95% confidence intervals (95% CI).
During the study period, there were 91,880 deliveries in the five hospitals and IUBT was used in 108 women to control bleeding. The success rate was 74.1% (80/108). In 28 women, invasive procedures were required (19 embolization and 9 surgical procedures with 5 peripartum hysterectomies). Women with failed IUBT were more often obese (25.9% vs. 8.1%; p = 0.03), duration of labor was shorter (363.9 min vs. 549.7min; p = 0.04), and major PPH (≥1,500 mL) before IUBT was more frequent (64% vs. 40%; p = 0.04). Obesity was a predictive factor of failed IUBT (aOR 4.40, 95% CI 1.06-18.31). Major PPH before IUBT seemed to be another predictor of failure (aOR 1.001, 95% CI 1.000-1.002), but our result did not reach statistical significativity.
Intrauterine balloon tamponade is an effective second line therapy for persistent primary PPH after vaginal delivery. Pre-pregnancy obesity is a risk factor of IUBT failure.
确定经阴道分娩后持续性产后出血（PPH）行宫腔内球囊填塞（IUBT）失败的预测因素。
在围产期网络中的五个产科单位进行回顾性病例系列研究。
所有于 2011 年 1 月至 2015 年 12 月期间在这些医院因经阴道分娩后持续性 PPH 而行 IUBT 的女性。
所有产科均采用相同的 PPH 管理政策。IUBT 采用 Bakri 球囊，作为经阴道分娩后，双合诊子宫按摩和缩宫素治疗失败后，控制持续性 PPH 的二线治疗方法。在 IUBT 后需要另一种二线治疗（栓塞或手术）以止血的女性定义为病例，而 IUBT 止血的女性定义为对照组。我们使用多元回归确定 IUBT 失败的独立预测因素，并使用调整后的优势比（aOR）和 95%置信区间（95%CI）对人口统计学因素进行调整。
在研究期间，五个医院共进行了 91880 次分娩，有 108 名女性接受 IUBT 以控制出血。成功率为 74.1%（80/108）。在 28 名女性中，需要进行侵入性操作（19 例栓塞和 9 例手术，其中 5 例行产后子宫切除术）。IUBT 失败的女性更常肥胖（25.9%比 8.1%；p=0.03），产程更短（363.9 分钟比 549.7 分钟；p=0.04），且 IUBT 前发生大量 PPH（≥1500mL）更常见（64%比 40%；p=0.04）。肥胖是 IUBT 失败的预测因素（aOR 4.40，95%CI 1.06-18.31）。IUBT 前大量 PPH 似乎也是失败的另一个预测因素（aOR 1.001，95%CI 1.000-1.002），但我们的结果未达到统计学显著性。
宫腔内球囊填塞是经阴道分娩后持续性原发性 PPH 的有效二线治疗方法。孕前肥胖是 IUBT 失败的危险因素。
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