Control of Postpartum Hemorrhage Using Vacuum-Induced Uterine Tamponade.
BACKGROUND
Postpartum hemorrhage is the leading cause of maternal mortality worldwide. Vacuum-induced uterine tamponade is a possible alternative approach to balloon tamponade systems for the treatment of postpartum hemorrhage resulting from atony.


METHODS
In a prospective proof-of-concept investigation of 10 women with vaginal deliveries in a hospital setting who failed first-line therapies for postpartum hemorrhage, tamponade was used. Vacuum-induced uterine tamponade was created through a device inserted transvaginally into the uterine cavity. An occlusion balloon built into the device shaft was inflated at the level of the external cervical os to create a uterine seal. Negative pressure was created by attaching a self-contained, mobile, electrically powered, pressure-regulated vacuum pump with a sterile graduated canister.


RESULTS
In all 10 cases, the suction created an immediate seal at the cervical os, 50-250 mL of residual blood was evacuated from the uterine cavity, the uterus collapsed and regained tone within minutes, and hemorrhaging was controlled. The device remained in place for a minimum of 1 hour and up to 6.5 hours in one case while vaginal and perineal lacerations were easily repaired.


CONCLUSIONS
This preliminary investigation suggests that a device designed to create vacuum-induced uterine tamponade may be a reasonable alternative to other devices used to treat atonic postpartum hemorrhage.
Department of Obstetrics and Gynecology, University of Indonesia, Jakarta, Indonesia; St. George's Medical School, London, England; and the Fogarty Institute for Innovation, San Luis Obispo, California.
Yuditiya
Y
Purwosunu
Widyastuti
W
Sarkoen
Sabaratnam
S
Arulkumaran
Jan
J
Segnitz
D000328:Adult; D036861:Delivery, Obstetric / Q000009:adverse effects*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007214:Indonesia; D006473:Postpartum Hemorrhage / Q000209:etiology / Q000628:therapy; D011247:Pregnancy; D011446:Prospective Studies; D016896:Treatment Outcome; D058738:Uterine Balloon Tamponade / Q000379:methods*; D014593:Uterine Inertia / Q000209:etiology / Q000628:therapy