EFFECTIVENESS OF UTERINE TAMPONADE DEVICES FOR REFRACTORY POSTPARTUM
HAEMORRHAGE AFTER VAGINAL BIRTH: A SYSTEMATIC REVIEW AND META-ANALYSIS
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.