Please note: Importing new articles from Word documents is currently unavailable. We are working on fixing this issue soon and apologize for any inconvenience.

loading page

EFFECTIVENESS OF UTERINE TAMPONADE DEVICES FOR REFRACTORY POSTPARTUM HAEMORRHAGE AFTER VAGINAL BIRTH: A SYSTEMATIC REVIEW AND META-ANALYSIS
  • +7
  • Veronica Pingray,
  • Mariana Widmer,
  • Agustín Ciapponi,
  • Gabriela Cormick,
  • Kitty Bloemenkamp,
  • Catherine Deneux-Tharaux,
  • Ahmet Gulmezoglu,
  • GJ Hofmeyr,
  • Olufemi Oladapo,
  • Fernando Althabe
Veronica Pingray
Institute for Clinical Effectiveness and Health Policy (IECS-CONICET)

Corresponding Author:[email protected]

Author Profile
Mariana Widmer
World Health organization
Author Profile
Agustín Ciapponi
Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
Author Profile
Gabriela Cormick
Institute for Clinical Effectiveness and Health Policy (IECS- CONICET)
Author Profile
Kitty Bloemenkamp
Department of Obstetrics, Birth Centre Wilhelmina’s Children Hospital, Division Woman and Baby, University Medical Center Utrecht
Author Profile
Catherine Deneux-Tharaux
INSERM
Author Profile
Ahmet Gulmezoglu
Concept Foundation
Author Profile
GJ Hofmeyr
University of Botswana, Gaborone, Botswana; Effective Care Research Unit, University of the Witwatersrand/Fort Hare
Author Profile
Olufemi Oladapo
World Health Organization
Author Profile
Fernando Althabe
Organisation mondiale de la Sante
Author Profile

Abstract

Objectives: to describe available uterine tamponade devices for the management of postpartum haemorrhage, and to evaluate its effectiveness as a treatment of refractory PPH. Search strategy: Databases searched included PubMed, EMBASE, CINAHL, LILACS and POPLINE. Study selection: To describe uterine tamponade devices any type of study was included; only randomised and non-randomised comparative studies were included to assess the effectiveness of uterine tamponade devices. Outcomes: The primary outcomes were: a composite outcome including surgical interventions or maternal death, and hysterectomy. Results: Twenty-four types of tamponade devices were identified. The Bakri and the condom-catheter balloon were the most frequently reported. One randomised controlled trial suggests non-significant increases in the composite outcome (RR 2.33, 95%CI 0.76-7.14) and hysterectomy (RR 4.14, 95%CI 0.48-35.93) associated with the condom-catheter balloon vs. no device. Another RCT suggests a non-significant reduction in the composite outcomes (RR 0.60; 95%CI 0.16-2.31) and hysterectomy (RR=0.5; 95%CI 0.05-5.25) with the Bakri balloon vs the condom-catheter balloon. A stepped-wedge study suggests an increase in the composite outcome (RR 4.08, 95%CI 1.07-15.58), and a non-significant increase in hysterectomies (RR 4.38, 95% CI 0.47-41.09) associated with the introduction of condom-catheter or surgical glove balloon into clinical settings. Conversely, non-randomised studies showed a non-statistically significant reduction (RR=0.61, 95%CI 0.27-1.40) in the composite outcome and no effect on hysterectomy associated with the use of the Bakri balloon. Conclusions: The effect of UBT for the management of atonic refractory PPH after vaginal delivery is unclear, as is the role of the type of device and the setting.