title: Is There an Association Between Indication for Intrauterine Balloon Tamponade and Balloon Failure?
abstract: ObjectiveDetermine whether the indication for intrauterine balloon tamponade (IUBT) is associated with failure rates.Study DesignCohort study of women who underwent IUBT for postpartum hemorrhage (PPH) from 2007 to 2014. The indication was categorized as uterine atony or placental-site bleeding. Primary outcome was IUBT failure, defined as the need for uterine artery embolization or hysterectomy. Secondary outcomes were estimated blood loss (EBL) after balloon placement, transfusion of red blood cells (RBC), transfusion of fresh frozen plasma (FFP) and/or cryoprecipitate, and intensive care unit (ICU) admission.Results306 women underwent IUBT: 241 (78.8%) for uterine atony and 65 (21.2%) for placental site bleeding. Overall, 67 (21.9%) women experienced IUBT failure. The frequency of failure was similar in those with uterine atony compared with those with placental-site bleeding (21.2 vs 24.6%,p= 0.55). This finding persisted after adjusting for potential confounders (aOR, 0.97; 95% CI, 0.48-1.99). Median EBL after balloon placement (190 [interquartile range, 93-375] vs 195 [interquartile range, 103-500] mL,p= 0.46), and frequencies of RBC transfusion (62.7 vs 66.2%,p= 0.60), FFP and/or cryoprecipitate transfusion (25.3 vs 33.8%,p= 0.17), and ICU admission (12.4 vs 16.9%,p= 0.35) were also similar.ConclusionIUBT was similarly effective for managing PPH from uterine atony or placental-site bleeding.
authors.affiliation: Division of Maternal-Fetal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Moeun
authors.initials: M
authors.lastname: Son
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Brett D
authors.initials: BD
authors.lastname: Einerson
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Chicago School of Medicine, Chicago, Illinois.
authors.forename: Patrick
authors.initials: P
authors.lastname: Schneider
authors.affiliation: Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Ian C
authors.initials: IC
authors.lastname: Fields
authors.affiliation: Division of Maternal-Fetal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: William A
authors.initials: WA
authors.lastname: Grobman
authors.affiliation: Division of Maternal-Fetal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Emily S
authors.initials: ES
authors.lastname: Miller
mesh_terms: D000328:Adult; D017707:Erythrocyte Transfusion; D005169:Factor VIII / Q000627:therapeutic use; D005260:Female; D005340:Fibrinogen / Q000627:therapeutic use; D006801:Humans; D007044:Hysterectomy; D007362:Intensive Care Units; D010343:Patient Admission; D010922:Placenta Diseases / Q000628:therapy; D010949:Plasma; D006473:Postpartum Hemorrhage / Q000209:etiology* / Q000628:therapy*; D011247:Pregnancy; D019233:Retreatment; D012189:Retrospective Studies; D017211:Treatment Failure; D055357:Uterine Artery Embolization; D058738:Uterine Balloon Tamponade; D014593:Uterine Inertia / Q000628:therapy
chemical_list: C026912:cryoprecipitate coagulum; D005169:Factor VIII; D005340:Fibrinogen