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Clinical Obstetrics

Poster Session 3

(723) Intrauterine vacuum-induced tamponade versus intrauterine balloon-tamponade for postpartum hemorrhage management

Wednesday, February 14, 2024

8:30 AM – 10:00 AM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Emma Trawick Roberts, MD (she/her/hers)

Fellow Physician
University of North Carolina at Chapel Hill
Durham, NC, United States

Coauthor(s)

AW

Amber Watters, MD

Northwestern University Feinberg School of Medicine
Chicago, IL, United States
Bethany T Stetson, MD

Bethany T Stetson
Northwestern Memorial
CHICAGO, IL, United States

Objective: To compare the effectiveness of intrauterine vacuum-induced tamponade device (IUVT) versus intrauterine balloon-tamponade device (IUBT) for postpartum hemorrhage (PPH) management.

Study Design: This is a retrospective cohort study of patients who had an intrauterine tamponade device placed for management of PPH secondary to uterine atony from 4/2020-7/2023 at an academic medical center. Patients who underwent IUVT (Jada®) placement (n=152) were compared 1:1 to those who underwent IUBT (Bakri®) placement (n=152) prior to adoption of the Jada® device at the study institution. Primary outcomes were estimated blood loss (EBL), red blood cell (pRBC) transfusion, and failure of the device to control PPH. Secondary outcomes included time from hemorrhage identification to device placement, time spent in 1:1 nursing care, and length of stay. Cohorts were compared using bivariable and multivariable analyses.

Results: Patients in both cohorts were similar in age, race, ethnicity, body mass index (BMI) and route of delivery (p >0.05). Patients who underwent IUVT placement had a significantly lower EBL and fewer units transfused that those who underwent IUBT placement (p< 0.01) (Table). Difference in EBL persisted in multivariable regression analysis (p< 0.01). There was no difference in failure between devices in controlling PPH (p >0.05). Of the IUVT that failed, 8 (53.3%) patients were subsequently managed with IUBT, and 6 (75%) of those then required further interventions. Patients underwent IUVT placement earlier, and IUVT remained in place for less time (p< 0.01). Patients who underwent IUVT placement spent less time in 1:1 nursing care and had shorter lengths of stay overall (p< 0.01). There was no difference between cohorts in admission to ICU, postpartum infection, or rates of readmission (p >0.05).

Conclusion: IUVT is similarly effective to IUBT in managing postpartum hemorrhage due to atony. IUVT is associated with less blood loss, fewer transfusions, lower nursing utilization, and shorter lengths of stay, which has significant implications for patient safety and costs of care.