Division of Obstetrics, Gynaecology and Imaging Directorate, King Edward Memorial Hospital, Perth, Australia.
Division of Obstetrics & Gynaecology, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia.
J Obstet Gynaecol. 2021 Aug;41(6):854-859. doi: 10.1080/01443615.2020.1799341. Epub 2020 Oct 16.
Intrauterine balloon tamponade (IUBT) is an established fertility-sparing and life-saving treatment for postpartum haemorrhage. However, high-level evidence is lacking for specific aspects of its use. Our aim was to evaluate a large case series of IUBT to inform evidence-based clinical practice. 296 cases of IUBT over a three-year period at a tertiary obstetric referral centre were identified and reviewed. Demographic, clinical, and procedural outcome measures were collected; including rates of success and failure of IUBT, duration of tamponade, and complications. IUBT was successful in 265 (90%) of women and failed in 18 (6%). All failures occurred within six hours of balloon insertion. Once deemed stable and successful at six hours, no women required return to theatre or further intervention. The mean duration of intrauterine balloon tamponade was 18.5 hours. A large variance in clinical practice exists including duration of intrauterine balloon tamponade, and method and timing of removal. A number of changes informed by the results will be introduced and prospectively audited to improve IUBT use.Impact statement Intrauterine balloon tamponade (IUBT) is an important second-line treatment option in severe postpartum haemorrhage (PPH). IUBT is easy to use, is effective especially in the setting of uterine atony, and is associated with minimal complications. This study confirms the high rate of success for IUBT in controlling PPH. We found that after six hours, if deemed successful, it is rare that further intervention is required. In addition, tamponade beyond 12 hours, gradual or incremental deflation of the balloon, and antibiotic cover beyond the duration of tamponade are unlikely to yield any further safety benefit. Our findings suggest that women should not be required to fast for balloon removal; removal of the balloon should occur by 12 hours if deemed stable and adequately resuscitated; deflation and removal of the balloon can occur at once; and antibiotics should be ceased after balloon removal. These will allow women to mobilise and recover sooner, and improve flow and throughput in our high-acuity care areas.
宫腔球囊压迫（IUBT）是一种成熟的保留生育能力和拯救生命的产后出血治疗方法。然而，其使用的具体方面缺乏高级别的证据。我们的目的是评估大量的 IUBT 病例系列，以提供循证临床实践。在一家三级产科转诊中心的三年内，确定并回顾了 296 例 IUBT 病例。收集了人口统计学、临床和程序结果测量值；包括 IUBT 的成功率和失败率、球囊填塞时间和并发症。在 18 名（6%）妇女中 IUBT 成功，在 265 名（90%）妇女中失败。所有失败均发生在球囊插入后 6 小时内。一旦在 6 小时内被认为稳定且成功，就无需返回手术室或进一步干预。宫腔球囊填塞的平均时间为 18.5 小时。临床实践存在很大差异，包括宫腔球囊填塞的时间、移除的方法和时间。将根据结果引入并前瞻性审核一些更改，以改善 IUBT 的使用。
影响说明宫腔球囊压迫（IUBT）是严重产后出血（PPH）的重要二线治疗选择。IUBT 使用方便，在子宫收缩乏力的情况下尤其有效，并且与最小的并发症相关。本研究证实 IUBT 控制 PPH 的成功率很高。我们发现，六小时后，如果认为成功，很少需要进一步干预。此外，填塞超过 12 小时、球囊逐渐或递增放气以及填塞时间超过抗生素覆盖时间不太可能带来任何进一步的安全益处。我们的研究结果表明，不应该要求女性在移除球囊前禁食；如果认为稳定且充分复苏，应在 12 小时内移除球囊；可以立即放气和移除球囊；并且在移除球囊后应停止使用抗生素。这些将使女性能够更快地移动和恢复，改善我们高敏度护理区域的流量和吞吐量。
