Erin T. Welsh, MA , 2025-05-16 22:34:00
Key takeaways:
- Two postpartum hemorrhage-control devices resulted in similar rates of blood loss, transfusion and device failure.
- Earlier device placement led to significantly lower rates of transfusions and device failure.
MINNEAPOLIS — Women with postpartum hemorrhage had similar transfusion rates and blood loss with intrauterine balloon tamponade and vacuum-induced devices, with earlier placement reducing device failure and the need for transfusion, data show.
“Tools available to the clinician for treatment [of postpartum hemorrhage] have changed little,” Laurence E. Shields, MD, maternal-fetal medicine specialist at Dignity Health Perinatal & Women’s Center, said during a presentation at the ACOG Annual Clinical & Scientific Meeting. “Other than having standardized guidelines giving recommendations for the utilization of uterotonics, we still rely heavily on dilation and curettage, interventional radiology and hysterectomy, as well as hemorrhage-control devices, which traditionally have been balloon and, more recently, the addition of the JADA suction device.”
Women with postpartum hemorrhage had similar transfusion rates and blood loss with intrauterine balloon tamponade and vacuum-induced devices. Image: Adobe Stock
Shields and colleagues collected data on postpartum hemorrhage case audits at 65 facilities from August 2022 to February 2024 to compare the use of intrauterine balloon tamponade vs. vacuum-induced hemorrhage-control devices. These types of devices are recommended for stage 2 or 3 of the postpartum hemorrhage algorithm, according to the researchers.
Primary outcomes were quantitative blood loss after device placement, packed red blood cell transfusion rates, use of three or more packed red blood cell units and device failure.
During the study period, 123,292 deliveries occurred, with 4.8% resulting in postpartum hemorrhage. Of these cases, 11.2% were managed with postpartum hemorrhage-control devices: 45.1% with intrauterine balloon tamponade and 54.9% with vacuum-induced hemorrhage control.
The intrauterine balloon tamponade and vacuum-induced hemorrhage control devices had similar rates of quantitative blood loss (194 mL vs. 240 mL), packed red blood cell transfusion (59.7% vs. 50%) and device failure (7.7% vs. 8.5%).
In addition, compared with placement at a quantitative blood loss of 1,500 mL or more, earlier placement of either device between 1,000 and 1,499 mL led to significantly lower rates of packed red blood cell transfusion (70.3% vs. 39.1%), transfusion of three or more units of packed red blood cells (38.1% vs. 13.7%; P < .001) and device failure (12.9% vs. 3.4%).
“Our data suggests that placement of the device should occur between 1,000 to 1,500 mL,” Shields said. “Because of the similar outcomes, the choice of which device is used will need to consider factors such as cost and availability of the device. Ideally, all health care professionals should be trained in both devices.”
