Statement on uterine balloon tamponade in Postpartum hemorrhage (PPH)

Postpartum haemorrhage (PPH) remains the most common cause of maternal death worldwide. Uterine balloon tamponade (UBT) is a simple, inexpensive and readily available method used to treat this.

Suarez et al [1] carried out a systematic review and meta-analysis in January 2020, in which the authors analysed all ninety one eligible studies and found the highest success rates corresponded to uterine atony (87.1%), as opposed to morbidly adherent placental disease, or retained products (66.7 and 76.8% respectively). The frequency of complications attributed to UBT use was low (≤6.5%).

There are conflicting data, with some experimental studies suggesting no beneficial effect, but overall, the authors conclude that UBT has a high success rate for treating PPH and appears to be safe; also acknowledging that further research is needed to determine the most effective programmatic and health care delivery strategies on the introduction and use of UBT.

These findings were corroborated in a study by Adegoke et al, which looked at the use of UBT in Tanzania [2]. This study concluded that ease of use and the prospect of saving life and preserving fertility strongly promoted its use, whilst fear and lack of high-level buy-in hindered utilisation of the UBT.

While these data are not entirely consistent, UBT does appear to be a safe and effective way to reduce PPH, especially in the atonic uterus, which is the most common cause of PPH.
We welcome further work to add to these data, and to further explore how to effectively introduce UBT as part of a care bundle, in our collective efforts to tackle PPH, the leading cause of maternal death globally.

1. Suarez, S., et al., Uterine balloon tamponade for the treatment of postpartum hemorrhage: a systematic review and meta-analysis. Am J Obstet Gynecol, 2020.

2. Adegoke, O., et al., A condom uterine balloon device among referral facilities in Dar Es Salaam: an assessment of perceptions, barriers and facilitators one year after implementation. BMC Pregnancy Childbirth, 2020. 20(1): p. 34.