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Excessive duration of intrauterine balloon placement
Accepted Manuscript Excessive duration of intrauterine balloon placement S. Alouini, M.D., Ph.D. PII:
S0002-9378(17)30502-1
DOI:
10.1016/j.ajog.2017.04.001
Reference:
YMOB 11605
To appear in:
American Journal of Obstetrics and Gynecology
Received Date: 28 February 2017 Accepted Date: 3 April 2017
Please cite this article as: Alouini S, Excessive duration of intrauterine balloon placement, American Journal of Obstetrics and Gynecology (2017), doi: 10.1016/j.ajog.2017.04.001. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
S. Alouini, M.D., Ph.D.
SC
Department of Obstetrics and Gynecology
RI PT
Excessive duration of intrauterine balloon placement
M AN U
Regional Hospital Center of Orleans,
14 avenue de l’Hôpital, 45100, Orléans, France.
TE D
The Author reports no conflict of interest
EP
Einerson et al ‘(1) reported that there were no significant differences in post-partum hemorrhage (PPH) outcomes when the Bakri balloon was removed after 12 hours or before 12
24].
AC C
hours. In the group of 206 patients, the intrauterine balloon was removed after 21 hours [17-
However, the duration of intrauterine balloon (IUB) left in place seems very long compared to our study (2) and other recommendations (3). We inserted 61 Bakri balloons for severe PPH between 2009 and 2013 (2). The mean duration of intrauterine Balloon insertion was of 7 hours [5-9] to control the PPH.
ACCEPTED MANUSCRIPT The excessive time with the IUB in place is probably due to the persistence of hemorrhage whereas it should have been removed and other techniques used to control the hemorrhage.
Indeed, in this group (>12 hours of IUBT) 136 women of 206 (66 %) had blood loss > 200 ml
RI PT
after IUB placement, and 128 of 206 (62%) had a transfusion. When the tamponade test is inefficient to stop PPH an embolization or uterine hemostatic sutures (4) or vessel ligations are indicated (5).
SC
Moreover, this long time of IUB placement was complicated by chorioamnionitis for 21
M AN U
women of 206 (10 %) which in some cases could compromise their fertility.
Estimated blood loss before balloon placement was severe (2000 ml) in the two groups. Thus questioning why the balloon was not inserted more quickly.
Finally, the fact that the balloon was inserted during working day hours does not explain its
TE D
excessive duration in place. Heterogeneous practices of management of IUB are more probably the cause. A protocol should precise the timing of monitoring and management of
AC C
References
EP
the deflation of the balloon according to blood loss evaluation.
1. Einerson BD, Son M, Schneider P, et al. The association between intrauterine balloon tamponade duration and postpartum hemorrhage outcomes. Am J Obstet Gynecol 2017;216:300.e1-5. 2. Alouini S, Bedouet L Ramos A, Ceccaldi C, Evrard ML, Khadre K. Bakri balloon tamponade for severe post-partum haemorrhage: efficiency and fertility outcomes. J Gynecol Obstet Biol Reprod. 2015;44:171-5.
ACCEPTED MANUSCRIPT 3. [No authors listed]. Prevention and Management of Postpartum Haemorrhage: Green-top Guideline No. 52. BJOG. 2016;16. doi: 10.1111/1471-0528.14178. [Epub ahead of print]
4. Alouini S, Coly S, Mégier P, Lemaire B, Mesnard L, Desroches A. Multiple square sutures
RI PT
for postpartum hemorrhage: results and hysteroscopic assessment. Am J Obstet Gynecol. 2011;205:335.e1-6. .
5. Condous GS, Arulkumaran S, Symonds I, Chapman R, Sinha A,
SC
Razvi K. The “tamponade test” in the management of massive postpartum hemorrhage.
AC C
EP
TE D
M AN U
Obstet Gynecol 2003;101:767–72.
S0002-9378(17)30502-1
DOI:
10.1016/j.ajog.2017.04.001
Reference:
YMOB 11605
To appear in:
American Journal of Obstetrics and Gynecology
Received Date: 28 February 2017 Accepted Date: 3 April 2017
Please cite this article as: Alouini S, Excessive duration of intrauterine balloon placement, American Journal of Obstetrics and Gynecology (2017), doi: 10.1016/j.ajog.2017.04.001. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
S. Alouini, M.D., Ph.D.
SC
Department of Obstetrics and Gynecology
RI PT
Excessive duration of intrauterine balloon placement
M AN U
Regional Hospital Center of Orleans,
14 avenue de l’Hôpital, 45100, Orléans, France.
TE D
The Author reports no conflict of interest
EP
Einerson et al ‘(1) reported that there were no significant differences in post-partum hemorrhage (PPH) outcomes when the Bakri balloon was removed after 12 hours or before 12
24].
AC C
hours. In the group of 206 patients, the intrauterine balloon was removed after 21 hours [17-
However, the duration of intrauterine balloon (IUB) left in place seems very long compared to our study (2) and other recommendations (3). We inserted 61 Bakri balloons for severe PPH between 2009 and 2013 (2). The mean duration of intrauterine Balloon insertion was of 7 hours [5-9] to control the PPH.
ACCEPTED MANUSCRIPT The excessive time with the IUB in place is probably due to the persistence of hemorrhage whereas it should have been removed and other techniques used to control the hemorrhage.
Indeed, in this group (>12 hours of IUBT) 136 women of 206 (66 %) had blood loss > 200 ml
RI PT
after IUB placement, and 128 of 206 (62%) had a transfusion. When the tamponade test is inefficient to stop PPH an embolization or uterine hemostatic sutures (4) or vessel ligations are indicated (5).
SC
Moreover, this long time of IUB placement was complicated by chorioamnionitis for 21
M AN U
women of 206 (10 %) which in some cases could compromise their fertility.
Estimated blood loss before balloon placement was severe (2000 ml) in the two groups. Thus questioning why the balloon was not inserted more quickly.
Finally, the fact that the balloon was inserted during working day hours does not explain its
TE D
excessive duration in place. Heterogeneous practices of management of IUB are more probably the cause. A protocol should precise the timing of monitoring and management of
AC C
References
EP
the deflation of the balloon according to blood loss evaluation.
1. Einerson BD, Son M, Schneider P, et al. The association between intrauterine balloon tamponade duration and postpartum hemorrhage outcomes. Am J Obstet Gynecol 2017;216:300.e1-5. 2. Alouini S, Bedouet L Ramos A, Ceccaldi C, Evrard ML, Khadre K. Bakri balloon tamponade for severe post-partum haemorrhage: efficiency and fertility outcomes. J Gynecol Obstet Biol Reprod. 2015;44:171-5.
ACCEPTED MANUSCRIPT 3. [No authors listed]. Prevention and Management of Postpartum Haemorrhage: Green-top Guideline No. 52. BJOG. 2016;16. doi: 10.1111/1471-0528.14178. [Epub ahead of print]
4. Alouini S, Coly S, Mégier P, Lemaire B, Mesnard L, Desroches A. Multiple square sutures
RI PT
for postpartum hemorrhage: results and hysteroscopic assessment. Am J Obstet Gynecol. 2011;205:335.e1-6. .
5. Condous GS, Arulkumaran S, Symonds I, Chapman R, Sinha A,
SC
Razvi K. The “tamponade test” in the management of massive postpartum hemorrhage.
AC C
EP
TE D
M AN U
Obstet Gynecol 2003;101:767–72.