title: Hemostatic effect of intrauterine balloon for postpartum hemorrhage with special reference to concomitant use of "holding the cervix" procedure (Matsubara).
abstract: OBJECTIVE
  The intrauterine balloon (Balloon) has recently been widely used to achieve hemostasis for postpartum hemorrhage (PPH). We concomitantly used a novel method, "holding the cervix", with the Balloon to prevent Balloon prolapse and achieve hemostasis. We aimed to clarify the following three factors: 1) hemostatic success rate of Balloon use for PPH, 2) effect of holding the cervix on Balloon prolapse, and, 3) the rate of bleeding after Balloon insertion, possibly predictive of Balloon failure.
  
  
  METHODS
  We retrospectively examined 80 patients undergoing Balloon application for PPH in our institution. We defined "success" as achieving hemostasis with no requirement of additional invasive procedures, and "failure" as their requirement. Between success vs. failure, several parameters were compared. For statistical analyses, Fisher's exact test and Wilcoxon rank sum test were applied.
  
  
  RESULTS
  Excluding "unable to insert" patients, "holding the cervix" was performed in 56 (75%). Prolapse was less likely to occur in patients with than in those without "holding the cervix" (4 vs. 11%, respectively). The success rate in patients with "Balloon+holding the cervix" was 94%. Treatment for atonic bleeding and placenta previa (PP) showed similarly high success rates (97 and 94%, respectively). The rate of bleeding following Balloon insertion was significantly higher in failure than success cases (P=0.03) and all failure cases showed bleeding >250mL/h.
  
  
  CONCLUSIONS
  The "Balloon+holding the cervix" strategy achieved hemostasis in over 90% of primary PPH.
  
  
  METHODS
  for not only atonic bleeding but also PP showed a high success rate. Bleeding >250mL/h after Balloon insertion may indicate the requirement of additional invasive procedures.
authors.affiliation: Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Ogoyama
authors.affiliation: Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan. Electronic address: hironori@jichi.ac.jp.
authors.forename: Hironori
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan.
authors.forename: Rie
authors.initials: R
authors.lastname: Usui
authors.affiliation: Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Baba
authors.affiliation: Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan.
authors.forename: Hirotada
authors.initials: H
authors.lastname: Suzuki
authors.affiliation: Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan.
authors.forename: Akihide
authors.initials: A
authors.lastname: Ohkuchi
authors.affiliation: Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Matsubara
mesh_terms: D000328:Adult; D005260:Female; D006489:Hemostatic Techniques / Q000295:instrumentation* / Q000706:statistics & numerical data*; D006801:Humans; D006473:Postpartum Hemorrhage / Q000628:therapy*; D012189:Retrospective Studies
keywords: Atonic bleeding; Holding the cervix; Intrauterine balloon; Placenta previa; Postpartum hemorrhage