Bibliographic information
Recommendation
Uterine balloon tamponade is recommended for the treatment of postpartum haemorrhage due to uterine atony after vaginal birth in women who do not respond to standard first-line treatment, provided the following conditions are met: Immediate recourse to surgical intervention and access to blood products is possible if needed. A primary postpartum haemorrhage first-line treatment protocol (including the use of uterotonics, tranexamic acid, intravenous fluids) is available and routinely implemented. Other causes of postpartum haemorrhage (retained placental tissue, trauma) can be reasonably excluded. The procedure is performed by health personnel who are trained and skilled in the management of postpartum haemorrhage, including the use of uterine balloon tamponade. Maternal condition can be regularly and adequately monitored for prompt identification of any signs of deterioration.
Context specific recommendation
Only in specific contexts
Notes and Remarks
- The GDG acknowledged that the conditions listed above may not be operationalized in a standard and consistent manner across settings. It is uncertain which preconditions are the most important to obtain clinical benefits from uterine balloon tamponade, and this would benefit from further research. In setting these preconditions, the panel’s emphasis was on minimizing harm to the woman, which could result from failure to or delay in implementing other temporizing and more invasive PPH treatment, incorrect patient selection for application of uterine balloon tamponade, poor monitoring or lack of other essential components for quality PPH care.
- In settings where these conditions cannot be met, the GDG agreed that additional rigorous research evidence is needed to determine if the clinical benefits outweigh the potential harms of uterine balloon tamponade in such settings.
- There is currently insufficient evidence to determine the comparative effectiveness and safety of improvised devices or purpose-designed devices. Evidence for this recommendation came from trials that used improvised devices for which there were reported concerns or problems in placement, including delays in inserting the device.