Department of Obstetrics and Gynaecology, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Hong Kong.
BMC Pregnancy Childbirth. 2018 Nov 21;18(1):451. doi: 10.1186/s12884-018-2085-6.
The use of intrauterine balloon tamponade to manage postpartum hemorrhage is increasing. However, there is lack of studies on the menstrual and reproductive outcomes after such treatment. The purpose of this study is to explore the menstrual and reproductive outcomes for patients who had been managed by intrauterine balloon tamponade for severe postpartum hemorrhage in her index pregnancy.
All patients who had delivered in United Christian Hospital from January 2011 to June 2016 with severe postpartum hemorrhage (PPH) (blood loss> = 1 L) were identified by the labour ward delivery registry and a comprehensive obstetric database. Patients who had intrauterine balloon tamponade inserted were compared with those managed solely by uterotonic agents as controls. Patients who had hysterectomy or additional procedures performed, such as compression sutures or uterine artery embolization were excluded from both groups. A questionnaire on menses, fertility and reproductive outcomes was mailed to both groups of patients. Those that had not replied within 4 weeks would receive a telephone survey.
A total of 39 patients in the balloon tamponade group and 161 patients in the control group were recruited, which represented 87.0% of all eligible patients within the study period. The median follow up period was 45 months. All patients in the balloon tamponade group had return of menses after delivery. The majority of the patients (87.2%) in the balloon tamponade group had normal menstrual patterns in the 12 months after the index delivery as well as in the most recent 12 months. After excluding the patients with contraception, the subsequent pregnancy rate was 42.9% (9/21) in the balloon tamponade group compared to 45.9% (28/61) in the control group (p = 0.81). Among the 9 subsequent pregnancies in the balloon tamponade group, there were two miscarriages, one scar pregnancy, one induced abortion, while the remaining five were normal pregnancies with full term deliveries without intrauterine growth restriction. The majority of patients replied that they were satisfied with using Bakri balloon for PPH management in their index pregnancy.
Intrauterine balloon tamponade for the management of severe PPH appeared to pose little adverse effects on subsequent menstrual and reproductive function.
宫腔球囊压迫在产后出血管理中的应用越来越多。然而，关于这种治疗后的月经和生殖结局的研究还很少。本研究的目的是探讨因严重产后出血（PPH）（出血量≥1 L）而接受宫腔球囊压迫治疗的患者在其指数妊娠后的月经和生殖结局。
通过产房分娩记录和全面产科数据库，确定 2011 年 1 月至 2016 年 6 月期间在联合基督教医院分娩且患有严重 PPH（出血量≥1 L）的所有患者。将接受宫腔球囊压迫治疗的患者与仅接受缩宫素药物治疗的患者作为对照组进行比较。两组均排除行子宫切除术或其他手术（如压迫缝合或子宫动脉栓塞术）的患者。我们向两组患者邮寄了一份关于月经、生育和生殖结局的问卷。对于在 4 周内未回复的患者，我们将进行电话调查。
共招募了 39 名宫腔球囊压迫组患者和 161 名对照组患者，占研究期间所有符合条件患者的 87.0%。中位随访时间为 45 个月。宫腔球囊压迫组所有患者分娩后均恢复月经。压迫组中大多数患者（87.2%）在指数分娩后 12 个月和最近 12 个月内月经模式正常。排除避孕患者后，宫腔球囊压迫组的后续妊娠率为 42.9%（9/21），对照组为 45.9%（28/61）（p=0.81）。宫腔球囊压迫组的 9 次后续妊娠中，有 2 次流产、1 次瘢痕妊娠、1 次人工流产，其余 5 次为足月分娩，无胎儿宫内生长受限。大多数患者表示对在其指数妊娠中使用 Bakri 球囊治疗 PPH 感到满意。
宫腔球囊压迫治疗严重 PPH 似乎对随后的月经和生殖功能几乎没有不良影响。
