Cochrane · systematic review · CD013663
Mechanical and surgical interventions for treating primary postpartum haemorrhage
Kellie, FJ, Wandabwa, JN, Mousa, HA, et al. · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library
Pregnancy and ChildbirthAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
64
current version
GRADE rated
24
No studies
40
Included studies
NR
No studies 40 · 62.5%Ungraded 0 · 0%Very low 21 · 32.8%Low 3 · 4.7%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
External uterine compression (all methods) plus normal care compared to normal care for treating primary postpartum haemorrhage
Population: women diagnosed with primary PPH following vaginal birth. PPH was defined as quote: "blood loss > 500mL after delivery" p 601
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality due to bleeding ‐ not reported External uterine compression (all methods) plus normal care vs normal care | no estimate extracted | NR | No studies |
Hysterectomy to control bleeding ‐ not reported External uterine compression (all methods) plus normal care vs normal care | no estimate extracted | NR | No studies |
Serious maternal morbidity (renal or respiratory failure, cardiac arrest or multiple organ failure) ‐ not reported External uterine compression (all methods) plus normal care vs normal care | no estimate extracted | NR | No studies |
Number of women with total blood loss 1000 mL or more after randomisation ‐ not reported External uterine compression (all methods) plus normal care vs normal care | no estimate extracted | NR | No studies |
Mean blood loss (mL) (trialist defined) External uterine compression (all methods) plus normal care vs normal care | no estimate extracted | NR | No studies |
Blood transfusion (red cell or whole blood) External uterine compression (all methods) plus normal care vs normal care | RR 2.33 [0.66, 8.23] | 1 study · 64 participants | Very low Downgraded: risk of bias |
Side effects of the intervention (e.g. trauma, necrosis) ‐ not reported External uterine compression (all methods) plus normal care vs normal care | no estimate extracted | NR | No studies |
One uterine devascularisation technique (uterine arterial embolisation) versus another uterine devascularisation technique (surgical devascularisation plus B‐Lynch)
Population: treating primary postpartum haemorrhage
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality due to bleeding ‐ not reported One uterine devascularisation technique (uterine arterial embolisation) vs another uterine devascularisation technique (surgical devascularisation plus B‐Lynch) | no estimate extracted | NR | No studies |
Hysterectomy to control bleeding One uterine devascularisation technique (uterine arterial embolisation) vs another uterine devascularisation technique (surgical devascularisation plus B‐Lynch) | RR 0.73 [0.15, 3.57] | 1 study · 23 participants | Very low Downgraded: risk of bias |
Serious maternal morbidity (renal or respiratory failure, cardiac arrest or multiple organ failure) One uterine devascularisation technique (uterine arterial embolisation) vs another uterine devascularisation technique (surgical devascularisation plus B‐Lynch) | no estimate extracted | NR | No studies |
Number of women with total blood loss 1000 mL or more after randomisation One uterine devascularisation technique (uterine arterial embolisation) vs another uterine devascularisation technique (surgical devascularisation plus B‐Lynch) | no estimate extracted | NR | No studies |
Mean blood loss (mL) (trialist defined) One uterine devascularisation technique (uterine arterial embolisation) vs another uterine devascularisation technique (surgical devascularisation plus B‐Lynch) | no estimate extracted | NR | No studies |
Blood transfusion (red cell or whole blood) One uterine devascularisation technique (uterine arterial embolisation) vs another uterine devascularisation technique (surgical devascularisation plus B‐Lynch) | no estimate extracted | NR | No studies |
Side effects of the intervention (e.g. trauma, necrosis) One uterine devascularisation technique (uterine arterial embolisation) vs another uterine devascularisation technique (surgical devascularisation plus B‐Lynch) | RR 1.09 [0.08, 15.41] | 1 study · 23 participants | Very low Downgraded: risk of bias |
Intrauterine balloon tamponade plus normal care (misoprostol) compared to normal care (misoprostol) for treating primary postpartum haemorrhage
Population: women diagnosed with primary PPH following vaginal birth. Women were suspected to have PPH due to clinical atony and who were quote: "unresponsive to oxytocin and who needed additional uterotonics" p1. PPH was defined as quote: "visual estimation of excessive blood loss and patient status (blood pressure and cardiac frequency)" p 2 (Dumont 2017)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality due to bleeding Intrauterine balloon tamponade plus normal care (misoprostol) vs normal care (misoprostol) | RR 6.21 [0.77, 49.98] | 1 study · 116 participants | Very low Downgraded: risk of bias |
Hysterectomy to control bleeding Intrauterine balloon tamponade plus normal care (misoprostol) vs normal care (misoprostol) | RR 4.14 [0.48, 35.93] | 1 study · 116 participants | Very low Downgraded: risk of bias |
Serious maternal morbidity (renal or respiratory failure, cardiac arrest or multiple organ failure) Intrauterine balloon tamponade plus normal care (misoprostol) vs normal care (misoprostol) | no estimate extracted | NR | No studies |
Number of women with total blood loss 1000 mL or more after randomisation Intrauterine balloon tamponade plus normal care (misoprostol) vs normal care (misoprostol) | RR 1.52 [1.15, 2] | 1 study · 113 participants | Very low Downgraded: risk of bias |
Mean blood loss (mL) (trialist defined) Intrauterine balloon tamponade plus normal care (misoprostol) vs normal care (misoprostol) | no estimate extracted | NR | No studies |
Blood transfusion (red cell or whole blood) Intrauterine balloon tamponade plus normal care (misoprostol) vs normal care (misoprostol) | RR 1.49 [0.88, 2.51] | 1 study · 116 participants | Very low Downgraded: risk of bias |
Side effects of the intervention (e.g. trauma, necrosis) ‐ Severe shivering, diarrhoea, vomiting or high temperature Intrauterine balloon tamponade plus normal care (misoprostol) vs normal care (misoprostol) | no estimate extracted | 1 study · 116 participants | Very low Downgraded: risk of bias |
Intrauterine balloon tamponade (latex balloon inflated with air) plus cerclage and normal care compared to normal care for treating primary postpartum haemorrhage
Population: women with PPH, due to atony, following vaginal birth at home or in hospital (Soltan 2007)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality due to bleeding Intrauterine balloon tamponade (latex balloon inflated with air) plus cerclage and normal care vs normal care | no estimate extracted | 1 study · 240 participants | Very low Downgraded: risk of bias |
Hysterectomy to control bleeding Intrauterine balloon tamponade (latex balloon inflated with air) plus cerclage and normal care vs normal care | RR 0.14 [0.01, 2.74] | 1 study · 240 participants | Very low Downgraded: risk of bias |
Serious maternal morbidity (renal or respiratory failure, cardiac arrest or multiple organ failure) Intrauterine balloon tamponade (latex balloon inflated with air) plus cerclage and normal care vs normal care | no estimate extracted | NR | No studies |
Number of women with total blood loss 1000 mL or more after randomisation Intrauterine balloon tamponade (latex balloon inflated with air) plus cerclage and normal care vs normal care | no estimate extracted | NR | No studies |
Mean blood loss (mL) (trialist defined) Intrauterine balloon tamponade (latex balloon inflated with air) plus cerclage and normal care vs normal care | no estimate extracted | NR | No studies |
Blood transfusion (red cell or whole blood) Intrauterine balloon tamponade (latex balloon inflated with air) plus cerclage and normal care vs normal care | no estimate extracted | NR | No studies |
Side effects of the intervention (e.g. trauma, necrosis) ‐ trauma, pyrexia, allergic reaction Intrauterine balloon tamponade (latex balloon inflated with air) plus cerclage and normal care vs normal care | no estimate extracted | 1 study · 240 participants | Very low Downgraded: risk of bias |
Bakri balloon tamponade versus haemostatic square suturing to the lower segment of the uterus (intrauterine tamponade versus another mechanical/surgical method) for treating primary postpartum haemorrhage
Population: women with complete placenta praevia and intractable bleeding following caesarean section
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality due to bleeding Bakri balloon tamponade vs haemostatic square suturing to the lower segment of the uterus (intrauterine tamponade versus another mechanical/surgical method) | no estimate extracted | 1 study · 13 participants | Very low Downgraded: risk of bias |
Hysterectomy to control bleeding Bakri balloon tamponade vs haemostatic square suturing to the lower segment of the uterus (intrauterine tamponade versus another mechanical/surgical method) | no estimate extracted | 1 study · 13 participants | Very low Downgraded: risk of bias |
Serious maternal morbidity (renal or respiratory failure, cardiac arrest or multiple organ failure) Bakri balloon tamponade vs haemostatic square suturing to the lower segment of the uterus (intrauterine tamponade versus another mechanical/surgical method) | no estimate extracted | 1 study · 13 participants | Very low Downgraded: risk of bias |
Number of women with total blood loss 1000 mL or more after randomisation Bakri balloon tamponade vs haemostatic square suturing to the lower segment of the uterus (intrauterine tamponade versus another mechanical/surgical method) | no estimate extracted | NR | No studies |
Mean blood loss (mL) (trialist defined) Bakri balloon tamponade vs haemostatic square suturing to the lower segment of the uterus (intrauterine tamponade versus another mechanical/surgical method) | no estimate extracted | 1 study · 13 participants | Very low Downgraded: risk of bias |
Blood transfusion (red cell or whole blood) Bakri balloon tamponade vs haemostatic square suturing to the lower segment of the uterus (intrauterine tamponade versus another mechanical/surgical method) | RR 0.57 [0.14, 2.36] | 1 study · 13 participants | Very low Downgraded: risk of bias |
Side effects of the intervention (e.g. trauma, necrosis) Bakri balloon tamponade vs haemostatic square suturing to the lower segment of the uterus (intrauterine tamponade versus another mechanical/surgical method) | no estimate extracted | 1 study · 13 participants | Very low Downgraded: risk of bias |
Bakri balloon tamponade versus condom‐loaded Foley Catheter (one intrauterine tamponade compared to another intrauterine tamponade technique) for treating primary postpartum haemorrhage
Population: women with primary atonic postpartum haemorrhage following vaginal delivery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality due to bleeding Bakri balloon tamponade vs condom‐loaded Foley Catheter (one intrauterine tamponade compared to another intrauterine tamponade technique) | no estimate extracted | NR | No studies |
Hysterectomy to control bleeding Bakri balloon tamponade vs condom‐loaded Foley Catheter (one intrauterine tamponade compared to another intrauterine tamponade technique) | RR 0.5 [0.05, 5.25] | 1 study · 66 participants | Very low Downgraded: risk of bias |
Serious maternal morbidity (renal or respiratory failure, cardiac arrest or multiple organ failure) Bakri balloon tamponade vs condom‐loaded Foley Catheter (one intrauterine tamponade compared to another intrauterine tamponade technique) | no estimate extracted | NR | No studies |
Number of women with total blood loss 1000 mL or more after randomisation Bakri balloon tamponade vs condom‐loaded Foley Catheter (one intrauterine tamponade compared to another intrauterine tamponade technique) | no estimate extracted | NR | No studies |
Mean blood loss (mL) (trialist defined) Bakri balloon tamponade vs condom‐loaded Foley Catheter (one intrauterine tamponade compared to another intrauterine tamponade technique) | no estimate extracted | NR | No studies |
Blood transfusion (red cell or whole blood) Bakri balloon tamponade vs condom‐loaded Foley Catheter (one intrauterine tamponade compared to another intrauterine tamponade technique) | RR 0.97 [0.88, 1.06] | 1 study · 58 participants | Very low Downgraded: risk of bias, imprecision |
Side effects of the intervention (e.g. trauma, necrosis) Bakri balloon tamponade vs condom‐loaded Foley Catheter (one intrauterine tamponade compared to another intrauterine tamponade technique) | no estimate extracted | NR | No studies |
Bakri balloon tamponade+traction stitch versus Bakri balloon (one intrauterine tamponade compared to another intrauterine tamponade technique) for treating primary postpartum haemorrhage)
Population: women with primary atonic postpartum haemorrhage
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality due to bleeding Bakri balloon tamponade+traction stitch vs Bakri balloon (one intrauterine tamponade compared to another intrauterine tamponade technique) | no estimate extracted | NR | No studies |
Hysterectomy to control bleeding Bakri balloon tamponade+traction stitch vs Bakri balloon (one intrauterine tamponade compared to another intrauterine tamponade technique) | RR 0.2 [0.01, 3.97] | 1 study · 50 participants | Very low Downgraded: risk of bias |
Serious maternal morbidity (renal or respiratory failure, cardiac arrest or multiple organ failure) Bakri balloon tamponade+traction stitch vs Bakri balloon (one intrauterine tamponade compared to another intrauterine tamponade technique) | no estimate extracted | NR | No studies |
Number of women with total blood loss 1000 mL or more after randomisation Bakri balloon tamponade+traction stitch vs Bakri balloon (one intrauterine tamponade compared to another intrauterine tamponade technique) | no estimate extracted | NR | No studies |
Mean blood loss (mL) (trialist defined) Bakri balloon tamponade+traction stitch vs Bakri balloon (one intrauterine tamponade compared to another intrauterine tamponade technique) | no estimate extracted | NR | No studies |
Blood transfusion (red cell or whole blood) Bakri balloon tamponade+traction stitch vs Bakri balloon (one intrauterine tamponade compared to another intrauterine tamponade technique) | no estimate extracted | NR | No studies |
Side effects of the intervention (e.g. trauma, necrosis) Bakri balloon tamponade+traction stitch vs Bakri balloon (one intrauterine tamponade compared to another intrauterine tamponade technique) | no estimate extracted | NR | No studies |
Total blood loss >= 1000 mL (before and after randomisation, outcome not pre‐specified in our protocol) Bakri balloon tamponade+traction stitch vs Bakri balloon (one intrauterine tamponade compared to another intrauterine tamponade technique) | RR 1 [0.93, 1.08] | 1 study · 50 participants | Low Downgraded: risk of bias |
Intrauterine balloon tamponade (condom‐loaded catheter) versus uterovaginal packing (intrauterine tamponade versus another intrauterine tamponade method) for treating primary postpartum haemorrhage
Population: Women (aged between 20 and 40) diagnosed with primary PPH following 'normal' vaginal birth and unresponsive to medical treatment (Ashraf 2018)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality due to bleeding Intrauterine balloon tamponade (condom‐loaded catheter) vs uterovaginal packing (intrauterine tamponade versus another intrauterine tamponade method) | no estimate extracted | NR | No studies |
Hysterectomy to control bleeding Intrauterine balloon tamponade (condom‐loaded catheter) vs uterovaginal packing (intrauterine tamponade versus another intrauterine tamponade method) | no estimate extracted | NR | No studies |
Serious maternal morbidity (renal or respiratory failure, cardiac arrest or multiple organ failure) Intrauterine balloon tamponade (condom‐loaded catheter) vs uterovaginal packing (intrauterine tamponade versus another intrauterine tamponade method) | no estimate extracted | NR | No studies |
Number of women with total blood loss 1000 mL or more after randomisation Intrauterine balloon tamponade (condom‐loaded catheter) vs uterovaginal packing (intrauterine tamponade versus another intrauterine tamponade method) | no estimate extracted | NR | No studies |
Mean blood loss (mL) (trialist defined) Intrauterine balloon tamponade (condom‐loaded catheter) vs uterovaginal packing (intrauterine tamponade versus another intrauterine tamponade method) | no estimate extracted | NR | No studies |
Blood transfusion (red cell or whole blood) Intrauterine balloon tamponade (condom‐loaded catheter) vs uterovaginal packing (intrauterine tamponade versus another intrauterine tamponade method) | no estimate extracted | NR | No studies |
Side effects of the intervention (e.g. trauma, necrosis) ‐ fever Intrauterine balloon tamponade (condom‐loaded catheter) vs uterovaginal packing (intrauterine tamponade versus another intrauterine tamponade method) | RR 0.47 [0.38, 0.59] | 1 study · 212 participants | Very low Downgraded: risk of bias |
Modified B‐Lynch compression suture technique versus standard B‐Lynch compression suture (one uterine compression suture technique versus another uterine compression suture technique) for treating primary postpartum haemorrhage
Population: women with uncontrolled atonic PPH following caesarean section, and not responding to standard care (uterine massage, ecbolics and bimanual compression).
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality due to bleeding Modified B‐Lynch compression suture technique vs standard B‐Lynch compression suture (one uterine compression suture technique versus another uterine compression suture technique) | no estimate extracted | NR | No studies |
Hysterectomy to control bleeding Modified B‐Lynch compression suture technique vs standard B‐Lynch compression suture (one uterine compression suture technique versus another uterine compression suture technique) | RR 0.33 [0.11, 0.99] | 1 study · 160 participants | Low Downgraded: risk of bias |
Serious maternal morbidity (renal or respiratory failure, cardiac arrest or multiple organ failure) Modified B‐Lynch compression suture technique vs standard B‐Lynch compression suture (one uterine compression suture technique versus another uterine compression suture technique) | no estimate extracted | NR | No studies |
Number of women with total blood loss 1000 mL or more after randomisation Modified B‐Lynch compression suture technique vs standard B‐Lynch compression suture (one uterine compression suture technique versus another uterine compression suture technique) | no estimate extracted | NR | No studies |
Mean blood loss (mL) (trialist defined) Modified B‐Lynch compression suture technique vs standard B‐Lynch compression suture (one uterine compression suture technique versus another uterine compression suture technique) | no estimate extracted | NR | Low Downgraded: risk of bias |
Blood transfusion (red cell or whole blood) Modified B‐Lynch compression suture technique vs standard B‐Lynch compression suture (one uterine compression suture technique versus another uterine compression suture technique) | no estimate extracted | NR | No studies |
Side effects of the intervention (e.g. trauma, necrosis) Modified B‐Lynch compression suture technique vs standard B‐Lynch compression suture (one uterine compression suture technique versus another uterine compression suture technique) | no estimate extracted | NR | No studies |