Obstetrics and Gynecology Service, Beaujon Teaching Hospital, Clichy and Paris Diderot University, Clichy, France.
Obstetrics and Gynecology Service, Bichat Teaching Hospital, Paris and Paris Diderot University, Paris, France.
J Invest Surg. 2021 Apr;34(4):373-379. doi: 10.1080/08941939.2019.1637976. Epub 2019 Jul 19.
To evaluate the rate of success and practicability of the intrauterine tamponade balloon (ITB) for managing PPH as a fertility-sparing tool. a five-year retrospective monocentric study in a tertiary care center including patients transferred for severe PPH. In 231 patients, the success rate of ITB ( = 57), embolization ( = 58), and medical management ( = 114) was 84.21%, 74.13%, and 76.32%, respectively. Cesarean section during labor did not influence the risk of advanced interventional procedures (AIPs) for patients with ITB (odds ratio [OR] = 1.08) but did so in patients who were under expectant management in the intensive care (OR = 5.29). In the AIP subgroup of the ITB group, hemostasis was significantly deteriorated. Prothrombin time <50% (OR = 11.5), fibrinogen <2 g/L (OR = 6.88), and >4 red blood cells units (RBCs) transfused (OR = 17.2) were associated with a significantly higher risk of failure. Blood loss in the AIP patients in the embolization group was significantly higher. Patients requiring >4 units of RBCs were 22.9 times more likely to have an AIP ( = .0001). Compared with uterine embolization and medical management, ITB use in a tertiary care center was associated with lower risk of undergoing AIP, but further prospective study is required to confirm this.
为评估宫腔内填塞球囊(ITB)作为一种保留生育能力的工具治疗产后出血(PPH)的成功率和实用性,对一家三级保健中心进行了一项为期五年的回顾性单中心研究,纳入了因严重 PPH 而转来的患者。在 231 例患者中,ITB( = 57)、栓塞( = 58)和药物治疗( = 114)的成功率分别为 84.21%、74.13%和 76.32%。分娩时行剖宫产并不会增加 ITB 患者行高级介入治疗(AIPs)的风险(比值比 [OR] = 1.08),但会增加在重症监护室接受期待治疗的患者的风险(OR = 5.29)。在 ITB 组的 AIP 亚组中,止血效果明显恶化。凝血酶原时间 <50%(OR = 11.5)、纤维蛋白原 <2 g/L(OR = 6.88)和输注 >4 个单位的红细胞(OR = 17.2)与失败风险显著增加相关。栓塞组 AIP 患者的出血量明显更高。需要输注 >4 个单位红细胞的患者发生 AIP 的可能性高 22.9 倍( = .0001)。与子宫动脉栓塞和药物治疗相比,在三级保健中心使用 ITB 与行 AIP 的风险较低相关,但需要进一步的前瞻性研究来证实这一点。