Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA (Drs Phillips and Sakamoto).
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX (Dr Eppes).
Am J Obstet Gynecol MFM. 2023 Feb;5(2S):100739. doi: 10.1016/j.ajogmf.2022.100739. Epub 2022 Sep 1.
Obstetrical hemorrhage is the leading cause of maternal morbidity and mortality worldwide, and the rates of severe hemorrhage are increasing. There is a crucial need to expand treatment options for hemorrhage to address this global crisis. Over the last decade, the evolution of hemorrhage control devices has contributed to advancements in obstetrical hemorrhage management. The number of existing hemorrhage control devices and techniques has increased markedly in recent years, and new devices are in development. The current evidence for established and investigational hemorrhage control devices has been summarized in this review. Of note, 2 main categories of devices exist: traditional uterine tamponade and vacuum-induced uterine tamponade. Although traditional intrauterine balloon tamponade devices are currently used widely in postpartum hemorrhage management, novel hemorrhage control devices and techniques have been developed. These include the minisponge tamponade device, the Jada System, a modified Bakri balloon technique, and a suction tube uterine tamponade technique. Reassuring safety data and preliminary efficacy data from pilot studies of these novel techniques support the powerful role intrauterine devices can play in obstetrical hemorrhage management. This review aimed to improve awareness of device options so that continued efforts can be made to integrate new technology into hemorrhage management protocols. Well-designed studies inclusive of new hemorrhage control devices are essential to understanding where new technology fits into preexisting obstetrical hemorrhage algorithms. In addition, access to new tamponade technology remains limited on a global scale. Programs aimed at both increasing access to devices and expanding educational initiatives are essential to make new technology a standard component for hemorrhage management.
产科出血是全球孕产妇发病率和死亡率的主要原因，严重出血的发生率正在上升。因此，迫切需要扩大出血治疗的选择，以应对这一全球危机。在过去的十年中，出血控制设备的发展促进了产科出血管理的进步。近年来，现有的出血控制设备和技术数量显著增加，并且正在开发新的设备。本综述总结了现有和正在研究的出血控制设备的证据。值得注意的是，存在两种主要类别的设备：传统的子宫填塞和真空诱导的子宫填塞。虽然传统的宫腔内球囊填塞装置目前广泛应用于产后出血的管理，但新型的出血控制设备和技术也已得到开发。这些设备包括迷你海绵填塞装置、Jada 系统、改良的 Bakri 球囊技术以及吸管子宫填塞技术。这些新技术的初步安全性数据和初步疗效数据支持宫内装置在产科出血管理中发挥重要作用。本综述旨在提高对设备选择的认识，以便继续努力将新技术纳入出血管理方案。包括新型出血控制设备的设计良好的研究对于了解新技术在现有的产科出血算法中的应用至关重要。此外，在全球范围内，新的填塞技术的应用仍然受到限制。旨在增加设备可及性和扩大教育计划的项目对于使新技术成为出血管理的标准组成部分至关重要。
