title: Intrauterine balloon tamponade for management of severe postpartum haemorrhage in a perinatal network: a prospective cohort study.
abstract: OBJECTIVE
  To evaluate the effectiveness of intrauterine balloon tamponade (IUBT) for management of severe postpartum haemorrhage (PPH). To identify the factors predicting IUBT failure.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Ten maternity units in a perinatal network.
  
  
  METHODS
  Women treated by IUBT from July 2010 to March 2013.
  
  
  METHODS
  The global IUBT success rate was expressed as the number of women with severe PPH who were successfully treated by IUBT divided by the total number treated by IUBT. IUBT failure was defined as the need for arterial embolisation or surgery. Logistic regression analysis was used to estimate factors predicting IUBT failure.
  
  
  METHODS
  Global IUBT success rate. Factors associated with IUBT failure.
  
  
  RESULTS
  Intrauterine balloon tamponade was attempted in 226 women: 171 after vaginal delivery (VD) (75.7%) and 55 during or after caesarean delivery (CD) (24.3%). The global success rate was 83.2% (188/226) and was significantly higher after VD (152/171, 88.9%) than CD (36/55, 65.5%, P < 0.01). The percentage of CD was significantly higher in the failure group (50.0 versus 19.1%, P < 0.01), as was mean (SD) estimated blood loss before IUBT: 1508 ± 675 ml versus 1064 ± 476, P < 0.01. Coagulopathy was significantly more frequent in the failure group (50.0% versus 17.2%, P < 0.01). CD [Odds ratio (OR) 3.5; 95% CI 1.6-7.6], estimated blood loss before IUBT (OR 3.2; 95% CI 1.5-6.8) and coagulopathy (OR 5.6; 95% CI 2.5-13.0) were predictive of IUBT failure.
  
  
  CONCLUSIONS
  Intrauterine balloon tamponade is an effective method for treating severe PPH. Early balloon deployment before the development of coagulopathy increases its success rate.
  
  
  CONCLUSIONS
  Intrauterine balloon tamponade is effective for achieving haemostasis in intractable postpartum haemorrhages.
authors: EA 7285, Versailles Saint Quentin University, Versailles, France.
authors: M
authors: M
authors: Revert
authors: Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France.|Bourgogne Franche-Comté University, Dijon, France.
authors: J
authors: J
authors: Cottenet
authors: Department of Obstetrics and Gynaecology, André Mignot Hospital, Versailles, France.
authors: P
authors: P
authors: Raynal
authors: Department of Obstetrics and Gynaecology, Poissy Saint-Germain Hospital, Poissy, France.
authors: E
authors: E
authors: Cibot
authors: Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France.|Bourgogne Franche-Comté University, Dijon, France.|Inserm, CIC 1432, Dijon, France.|Dijon University Hospital, Clinical Investigation Center, Dijon, France.|Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Villejuif, France.
authors: C
authors: C
authors: Quantin
authors: EA 7285, Versailles Saint Quentin University, Versailles, France.|Department of Obstetrics and Gynaecology, Poissy Saint-Germain Hospital, Poissy, France.
authors: P
authors: P
authors: Rozenberg
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects; D019058:Community Networks / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D016015:Logistic Models; D018743:Perinatal Care / Q000706:statistics & numerical data*; D006473:Postpartum Hemorrhage / Q000209:etiology / Q000628:therapy*; D011247:Pregnancy; D011446:Prospective Studies; D013997:Time Factors; D017211:Treatment Failure; D058738:Uterine Balloon Tamponade / Q000706:statistics & numerical data*
keywords: Bakri balloon; Belfort-Dildy Obstetrical Tamponade System; ebb balloon; intrauterine balloon tamponade; postpartum haemorrhage