Comparison of outcome between intrauterine balloon tamponade and uterine artery embolization in the management of persistent postpartum hemorrhage: A propensity score-matched cohort study

Paul I. Ramler, Dacia D. C. A. Henriquez, Thomas van den Akker, Camila Caram-Deelder, Rolf H. H. Groenwold, Kitty W. M. Bloemenkamp, Jos van Roosmalen, Jan M. M. van Lith, Johanna G. van der Bom, the TeMpOH-1 study group

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Introduction: The aim of this study was 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 languageEnglish
Pages (from-to)1473-1482
Number of pages10
JournalActa Obstetricia et Gynecologica Scandinavica
Volume98
Issue number11
DOIs
Publication statusPublished - 1 Nov 2019
Externally publishedYes

Cite this

Ramler, P. I., Henriquez, D. D. C. A., van den Akker, T., Caram-Deelder, C., Groenwold, R. H. H., Bloemenkamp, K. W. M., ... the TeMpOH-1 study group (2019). Comparison of outcome between intrauterine balloon tamponade and uterine artery embolization in the management of persistent postpartum hemorrhage: A propensity score-matched cohort study. Acta Obstetricia et Gynecologica Scandinavica, 98(11), 1473-1482. https://doi.org/10.1111/aogs.13679
Ramler, Paul I. ; Henriquez, Dacia D. C. A. ; van den Akker, Thomas ; Caram-Deelder, Camila ; Groenwold, Rolf H. H. ; Bloemenkamp, Kitty W. M. ; van Roosmalen, Jos ; van Lith, Jan M. M. ; van der Bom, Johanna G. ; the TeMpOH-1 study group. / Comparison of outcome between intrauterine balloon tamponade and uterine artery embolization in the management of persistent postpartum hemorrhage: A propensity score-matched cohort study. In: Acta Obstetricia et Gynecologica Scandinavica. 2019 ; Vol. 98, No. 11. pp. 1473-1482.
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title = "Comparison of outcome between intrauterine balloon tamponade and uterine artery embolization in the management of persistent postpartum hemorrhage: A propensity score-matched cohort study",
abstract = "Introduction: The aim of this study was 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.",
keywords = "intrauterine balloon tamponade, maternal mortality, peripartum hysterectomy, postpartum hemorrhage, propensity score, severe maternal outcome, uterine artery embolization",
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Ramler, PI, Henriquez, DDCA, van den Akker, T, Caram-Deelder, C, Groenwold, RHH, Bloemenkamp, KWM, van Roosmalen, J, van Lith, JMM, van der Bom, JG & the TeMpOH-1 study group 2019, 'Comparison of outcome between intrauterine balloon tamponade and uterine artery embolization in the management of persistent postpartum hemorrhage: A propensity score-matched cohort study' Acta Obstetricia et Gynecologica Scandinavica, vol. 98, no. 11, pp. 1473-1482. https://doi.org/10.1111/aogs.13679

Comparison of outcome between intrauterine balloon tamponade and uterine artery embolization in the management of persistent postpartum hemorrhage: A propensity score-matched cohort study. / Ramler, Paul I.; Henriquez, Dacia D. C. A.; van den Akker, Thomas; Caram-Deelder, Camila; Groenwold, Rolf H. H.; Bloemenkamp, Kitty W. M.; van Roosmalen, Jos; van Lith, Jan M. M.; van der Bom, Johanna G.; the TeMpOH-1 study group.

In: Acta Obstetricia et Gynecologica Scandinavica, Vol. 98, No. 11, 01.11.2019, p. 1473-1482.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Comparison of outcome between intrauterine balloon tamponade and uterine artery embolization in the management of persistent postpartum hemorrhage: A propensity score-matched cohort study

AU - Ramler, Paul I.

AU - Henriquez, Dacia D. C. A.

AU - van den Akker, Thomas

AU - Caram-Deelder, Camila

AU - Groenwold, Rolf H. H.

AU - Bloemenkamp, Kitty W. M.

AU - van Roosmalen, Jos

AU - van Lith, Jan M. M.

AU - van der Bom, Johanna G.

AU - the TeMpOH-1 study group

PY - 2019/11/1

Y1 - 2019/11/1

N2 - Introduction: The aim of this study was 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.

AB - Introduction: The aim of this study was 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.

KW - intrauterine balloon tamponade

KW - maternal mortality

KW - peripartum hysterectomy

KW - postpartum hemorrhage

KW - propensity score

KW - severe maternal outcome

KW - uterine artery embolization

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UR - https://www.ncbi.nlm.nih.gov/pubmed/31240693

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DO - 10.1111/aogs.13679

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JO - Acta Obstetricia et Gynecologica Scandinavica

JF - Acta Obstetricia et Gynecologica Scandinavica

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