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Balloon Tamponade Works When Oxytocin and Other Uterotonics Fail to Stop Postpartum Bleeding: Presented at ACOG
By Maggie Schwarz
WASHINGTON, D.C. -- May 11, 2006 -- Positive results with balloon tamponade to stop postpartum hemorrhage were reported here at the 54th Annual Clinical Meeting of the American College of Obstetricians and Gynecologists (ACOG).
Victor G. Dabelea, MD, resident in obstetrics and gynecology, Exempla St. Joseph Hospital, Denver, Colorado, and colleagues conducted a 2-year retrospective review of 24 cases who had received oxytocin; 20 of these patients had received other uterotonics.
In balloon tamponade of the uterus, the balloon exerts pressure on bleeding areas and stops bleeding. "This procedure is easy and efficient and would be a huge advantage in settings where you could not proceed immediately to hysterectomy. Such settings would be those where no blood products or operating room are available," Dr. Dabelea explained.
In 3 of the 24 cases, technical difficulties led to placement failure. When properly placed, catheters controlled postpartum hemorrhage in 90.4% of 21 cases. In 2 of these cases, hysterectomy was required despite successful placement of the catheter (1 due to placenta accreta and 1 to amniotic fluid embolism).
For hemorrhage due to uterine atony, the success rate was 100% of 12 cases. For bleeding due to retained products of conception, the success rate was 80% of 5 (failure with placenta accreta). Vaginal bleeding was stopped with the catheter in 2 of 3 cases of amniotic fluid embolus, and in 1 case after dilatation and curettage for postpartum septic shock.
Postpartum hemorrhage complicates 3% to 5% of deliveries and may require hysterectomy or uterine artery embolization when unresponsive to oxytocin or other uterotonics, Dr. Dabelea said.
He concluded that balloon tamponade is an effective adjunct in the treatment of severe postpartum hemorrhage, especially when the hemorrhage is due to uterine atony.
[Presentation title: Intrauterine Balloon Tamponade in the Management of Postpartum Hemorrhage. Abstract p. 38S]
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