Elshamy Elsayed, Rezk Mohamed, Shaheen Abd-Elhamid
Department of Obstetrics and Gynecology, Menoufia University Hospital, Menoufia, Egypt.
Department of Obstetrics and Gynecology, King Abdul-Aziz Airbase Hospital, 041/9 Prince Sattam street, Al-Khobar, Dhahran, Saudi Arabia.
Arch Gynecol Obstet. 2023 Apr;307(4):1195-1201. doi: 10.1007/s00404-022-06543-y. Epub 2022 Apr 9.
To assess the safety and effectiveness of uterine packing with gauze compared to Bakri balloon to control postpartum hemorrhage (PPH) after vaginal delivery in patients with hypertensive disorders with pregnancy (HDP).
This was a prospective observational study conducted on 142 patients with HDP who suffered atonic PPH following vaginal delivery and were allocated either to insert uterine packing with gauze (n = 68) or insertion of Bakri balloon (n = 74). Success of the tamponade to arrest bleeding was the primary outcome measure. Data was collected and analyzed.
Most of the included patients experienced spontaneous onset of labour (69%), had not receive I.V. antihypertensive drugs (83.1%) or magnesium sulphate (94.4%), or calcium channel blocker (95.7%), underwent spontaneous vaginal delivery (85.9%), received Pethidine by IMI for pain relief during labour (67.6%), did not need an episiotomy (59.2%), with spontaneous delivery of the placenta (95.77%). Bakri balloon was associated with a shorter duration to insert (p < 0.001), a higher failure rate with the need for laparotomy (p < 0.05) and more post-delivery hospital stay compared to uterine packing (p < 0.001).
Although uterine packing with gauze to control PPH after vaginal delivery in patients with HDP requires a longer time to insert compared to Bakri balloon yet associated with a lesser need for laparotomy and shorter hospital stay. Larger trials are warranted to confirm or refute these findings.
评估与 Bakri 球囊相比，使用纱布进行子宫填塞控制妊娠高血压疾病（HDP）患者阴道分娩后产后出血（PPH）的安全性和有效性。
这是一项前瞻性观察性研究，对 142 例 HDP 患者进行，这些患者在阴道分娩后发生宫缩乏力性 PPH，并被分配接受纱布子宫填塞（n = 68）或插入 Bakri 球囊（n = 74）。压迫止血成功是主要结局指标。收集并分析数据。
大多数纳入患者自然发动分娩（69%），未接受静脉注射降压药物（83.1%）或硫酸镁（94.4%）或钙通道阻滞剂（95.7%），经阴道自然分娩（85.9%），在分娩期间通过肌内注射哌替啶缓解疼痛（67.6%），无需会阴切开术（59.2%），胎盘自然娩出（95.77%）。与子宫填塞相比，Bakri 球囊插入时间更短（p < 0.001），剖腹手术失败率更高（p < 0.05），产后住院时间更长（p < 0.001）。
尽管与 Bakri 球囊相比，HDP 患者阴道分娩后使用纱布进行子宫填塞控制 PPH 的插入时间更长，但剖腹手术需求较少且住院时间较短。需要更大规模的试验来证实或反驳这些发现。
