Abstract
Introduction: To compare the outcomes of women who were initially managed by intrauterine balloon tamponade or uterine artery embolization because of persistent postpartum hemorrhage demanding an immediate intervention to control bleeding. Material and methods: Propensity score-matched cohort study including women who had intrauterine balloon tamponade or uterine artery embolization as initial management strategy to control persistent postpartum hemorrhage, that is, refractory to first-line therapy combined with at least one uterotonic agent. The primary outcome measure was a composite of peripartum hysterectomy and/or maternal mortality. Secondary outcomes measures were total volume of blood loss and total number of packed red blood cells transfused. Results: Our 1:1 propensity score-matched cohort comprised of 50 women who had intrauterine balloon tamponade and 50 women who underwent uterine artery embolization at a blood loss between 1000 and 7000 mL. There was no statistically significant difference in the hysterectomy risk between the two groups (n = 6 in each group, odds ratio [OR] 1.00, 95% confidence interval [CI].30-3.34), in total volume of blood loss (median 4500 mL, interquartile range [IQR] 3600-5400) for balloon vs 4000 mL (IQR 3250-5000) for embolization, P = 0.382) or in total units of packed red blood cells transfused (median 7 (IQR 5-10) for balloon vs 6 [IQR 4-9] for embolization, P = 0.319). Fifteen women (30%) who were initially managed by an intrauterine balloon still underwent uterine artery embolization, of whom one had an embolization-related thrombo-embolic event. Maternal mortality occurred in neither of the intervention groups. Conclusions: No difference in the risk of peripartum hysterectomy and/or maternal death was observed between women who had intrauterine balloon tamponade and women who underwent uterine artery embolization as an initial management for persistent postpartum hemorrhage. Although this study was underpowered to demonstrate equivalence, our study design provides a framework for future research in which intrauterine balloon tamponade may prove to be a suitable intervention of first choice in the management of persistent postpartum hemorrhage.
| Original language | English |
|---|---|
| Pages (from-to) | 1473-1482 |
| Number of pages | 10 |
| Journal | Acta Obstetricia et Gynecologica Scandinavica |
| Volume | 98 |
| Issue number | 11 |
| DOIs | |
| Publication status | Published - 1 Jan 2019 |
Funding
Funding information The study was supported by an internal grant from Sanquin Center for Clinical Transfusion Research (PPOC 11-023). Rolf H. H. Groenwold received funding from the Netherlands Organization for Scientific Research (ZonMw, project 917.16.430). The funding bodies had no role in the design, conduct or decision to publish this study. We thank all the 61 participating hospitals and the Dutch consortium for Healthcare Evaluation and Research in Obstetrics and Gynecology – NVOG Consortium 2.0. We thank all members of the TeMpOH-1 group le Cessie S, Eikenboom HCJ, So-Osman C, van de Watering LMG, Zwaginga JJ and Zwart JJ, medical students Loeff RM, van Goeverden RJ, Eijlers B, Hillebrand A, Spelmin SE, Beunder TJ, Harskamp V, Wind M, Koning MD, Cramer RA, Veenstra A, Smith SM and Ensing EE, data managers van Brussel-de Groot CJ, and Zouitni O, and the research nurses Kolster-Bijdevaate C, Bourgonje-Verhart MS, Bleeker-Taborh CE and Roos-van Milligen E for their contribution to the TeMpOH-1 study.
| Funders | Funder number |
|---|---|
| Dutch Consortium for Healthcare Evaluation and Research in Obstetrics and Gynecology | |
| Loeff RM | |
| Sanquin Center for Clinical Transfusion Research | PPOC 11-023 |
| ZonMw | 917.16.430 |
| Nederlandse Organisatie voor Wetenschappelijk Onderzoek |
Keywords
- intrauterine balloon tamponade
- maternal mortality
- peripartum hysterectomy
- postpartum hemorrhage
- propensity score
- severe maternal outcome
- uterine artery embolization
