Effectiveness of Uterine Tamponade Devices for Refractory Postpartum Hemorrhage After Vaginal Birth: A Systematic Review

(BJOG. 2021;128:1732–1743)Most postpartum hemorrhage (PPH) deaths occur due to uterine atony. While first-line interventions for PPH such as uterotonics, tranexamic acid, and uterine massage are effective for most patients, 10% to 20% of patients are unresponsive to these and are deemed to have “refractory” PPH. Uterine tamponade devices (UTD) used to treat refractory PPH include uterine balloon tamponade (UBT) and uterine suction tamponade (UST). The World Health Organization has previously issued a conditional recommendation for the use of UBT to treat refractory PPH due to uterine atony, based on case series and studies with no control population. Since then, several relevant studies, including randomized controlled trials, have been published. This systematic review aims to evaluate uterine tamponade devices for safety and effectiveness in treating atonic refractory PPH following vaginal birth and examine the effects of including uterine tamponade devices into institutional PPH protocols.