Cesarean section, Preeclampsia and uterine rupture risk factors for intrauterine tamponade failure in PPH

A new investigation found that Cesarean delivery, preeclampsia, and uterine rupture are the risk factors for intrauterine tamponade failure in the management of postpartum hemorrhage.

The study was published in the journal Obstetrics and Gynecology. 

Postpartum hemorrhage is the most common complication of childbirth. PPH is defined as cumulative blood loss greater than 1000 mL with signs and symptoms of hypovolemia within 24 hours of the birth process, regardless of the route of delivery. Intrauterine tamponade is the common method of treating uterine bleeding. Researchers conducted a study to identify the risk factors associated with intrauterine tamponade failure after vaginal or cesarean delivery. 

A nationwide population-based cohort study was done using data from the French Programme de Médicalisation des Systèmes d'Information to compare the failure and effectiveness of intrauterine tamponade among all women who received the procedure in France from January 1, 2019, to December 31, 2019. Failure of tamponade was defined as the use of a second-line method like uterine artery embolization, conservative or radical surgery, or death within 7 days of intrauterine tamponade. Factors associated with intrauterine tamponade failure were identified by univariate analyses and tested using multivariate generalized logistic regression models to obtain adjusted odds ratio (aOR) and 95% CI statistics.  

Results:

• A total of 39,193 patients presented with postpartum hemorrhage in 474 French maternity wards.
• Of these patients, 1,761 (4.5%) received intrauterine tamponade for persistent bleeding.
• Intrauterine tamponade showed an effective rate of 88.9%.
• A second-line method was indicated for 195 women (11.1%).
• Patients for whom intrauterine tamponade failed had higher maternal age, a lower mean gestational age, and more frequent instances of placental abnormalities, preeclampsia, cesarean birth, and uterine rupture.
• The multivariate analysis revealed that cesarean birth, preeclampsia, and uterine rupture were independently associated with intrauterine tamponade failure. 

Thus, the researchers revealed that Cesarean delivery, preeclampsia, and uterine rupture are the risk factors that are associated with intrauterine tamponade failure in the management of postpartum hemorrhage. 

For the full article, click here: 10.1097/AOG.0000000000004888

Gibier M, Pauly V, Orleans V, Fabre C, Boyer L, Blanc J. Risk Factors for Intrauterine Tamponade Failure in Postpartum Hemorrhage [published online ahead of print, 2022 Aug 3]. Obstet Gynecol. 2022;10.1097/AOG.0000000000004888.