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

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.