Shields Laurence E, Klein Catherine, Torti Jennie, Foster Mindy, Cook Curtis
Marian Regional Medical Center and CommonSpirit Health, Women and Infants Clinical Institute, Santa Maria, California; and the Dignity Health Medical Group, Phoenix, Arizona.
Obstet Gynecol. 2025 Jan 1;145(1):65-71. doi: 10.1097/AOG.0000000000005770. Epub 2024 Oct 24.
To compare intrauterine balloon tamponade and vacuum-induced hemorrhage-control devices in a multicenter hospital system using a standardized three-stage postpartum hemorrhage response algorithm.
As part of a quality improvement project, data were prospectively collected through ongoing detailed hemorrhage case audits from 65 facilities from August 2022 to February 2024. Postpartum hemorrhage-control devices are recommended for stage 2 or 3 of the postpartum hemorrhage algorithm. The primary outcomes were 1) quantitative blood loss after device placement, 2) rate of packed red blood cell (RBC) transfusion, 3) use of 3 units of packed RBCs or more, and 4) device failure.
During the 17-month observation period, there were 123,292 deliveries, and postpartum hemorrhage occurred in 5,931 (4.8%). Postpartum hemorrhage-control devices were used in 11.2% of cases (666 total, intrauterine balloon tamponade n=300, and vacuum-induced hemorrhage control n=366). For intrauterine balloon tamponade and vacuum-induced hemorrhage-control devices, quantitative blood loss (median and interquartile range) after device placement was similar at 194 (67-440) mL and 240 (113-528) mL ( P =.40), respectively, as was the rate of any packed RBC transfusion (59.7% vs 50.0%, P =.08), transfusion of 3 packed RBC units or more (27.0% vs 24.9%, P =.53), and device failure (7.7% vs 8.5%, P =.70). Placement of either device at a quantitative blood loss between 1,000 and 1,499 mL compared with 1,500 mL or more resulted in significantly lower rates of packed RBC transfusion (39.1% vs 70.3%, P <.001), transfusion of 3 or more packed RBC units (13.7 vs 38.1%, P <.001), and device failure (3.4% vs 12.9%, P <.001).
Transfusion and blood loss after device placement were similar with both hemorrhage-control devices. Earlier hemorrhage-control device placement reduced device failure and the need for transfusion.
在一个多中心医院系统中，使用标准化的三阶段产后出血应对算法，比较宫腔球囊填塞术和真空诱导止血装置。
作为质量改进项目的一部分，从2022年8月至2024年2月，通过对65家机构正在进行的详细出血病例审核，前瞻性收集数据。产后出血算法的第2或3阶段推荐使用产后出血控制装置。主要结局包括：1）放置装置后的失血量；2）红细胞（RBC）输注率；3）输注3个或更多单位红细胞；4）装置失败。
在17个月的观察期内，共分娩123292例，产后出血5931例（4.8%）。11.2%的病例使用了产后出血控制装置（共666例，宫腔球囊填塞术300例，真空诱导止血366例）。对于宫腔球囊填塞术和真空诱导止血装置，放置装置后的失血量（中位数和四分位数间距）相似，分别为194（67 - 440）mL和240（113 - 528）mL（P = 0.40），任何红细胞输注率（59.7%对50.0%，P = 0.08）、输注3个或更多单位红细胞（27.0%对24.9%，P = 0.53）以及装置失败率（7.7%对8.5%，P = 0.70）也相似。与失血量在1500 mL及以上相比，当失血量在1000至1499 mL之间时放置任何一种装置，红细胞输注率（39.1%对70.3%，P < 0.001）、输注3个或更多单位红细胞（13.7%对38.1%，P < 0.001）以及装置失败率（3.4%对12.9%，P < 0.001）均显著降低。
两种出血控制装置放置后的输血情况和失血量相似。早期放置出血控制装置可降低装置失败率和输血需求。
