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EFFECTIVENESS OF UTERINE TAMPONADE DEVICES FOR REFRACTORY POSTPARTUM HAEMORRHAGE AFTER VAGINAL BIRTH: A SYSTEMATIC REVIEW
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  • Veronica Pingray,
  • Mariana Widmer,
  • Agustín Ciapponi,
  • GJ Hofmeyr,
  • Catherine Deneux-Tharaux,
  • Ahmet Gulmezoglu,
  • Kitty Bloemenkamp,
  • Olufemi Oladapo,
  • Daniel Comande,
  • Ariel Bardach,
  • Paula Vazquez,
  • Gabriela Cormick,
  • Fernando Althabe
Veronica Pingray
Institute for Clinical Effectiveness and Health Policy (IECS-CONICET)
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Mariana Widmer
World Health organization
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Agustín Ciapponi
Institute for Clinical Effectiveness and Health Policy (IECS- CONICET)
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GJ Hofmeyr
University of Botswana
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Catherine Deneux-Tharaux
INSERM
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Ahmet Gulmezoglu
Concept Foundation
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Kitty Bloemenkamp
University Medical Centre Utrecht
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Olufemi Oladapo
World Health Organization
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Daniel Comande
Institute for Clinical Effectiveness and Health Policy (IECS-CONICET)
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Ariel Bardach
Institute for Clinical Effectiveness and Health Policy (IECS-CONICET)
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Paula Vazquez
Institute for Clinical Effectiveness and Health Policy (IECS-CONICET)
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Gabriela Cormick
Institute for Clinical Effectiveness and Health Policy (IECS- CONICET)
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Fernando Althabe
Organisation mondiale de la Sante
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Abstract

Objectives: to evaluate the effectiveness of uterine tamponade devices for atonic refractory postpartum haemorrhage (PPH) after vaginal birth, and the effect of including uterine tamponade devices in institutional protocols. Search strategy: databases in PubMed, EMBASE, CINAHL, LILACS and POPLINE. Study selection: randomised and non-randomised comparative studies. Outcomes: composite outcome including surgical interventions (artery ligations, uterine compressive sutures or hysterectomy) or maternal death, and hysterectomy. Results: all four included studies were at high risk of bias. The certainty of evidence rated as very low to low. One randomised study measured the effect of the the condom-catheter balloon compared to standard care and found unclear results for the composite outcome (RR 2.33, 95%CI 0.76-7.14) and hysterectomy (RR 4.14, 95%CI 0.48-35.93). Three comparative studies assessed the effect of including UBTs in institutional protocols. A stepped-wedge study suggested an increase in the composite outcome (RR 4.08, 95%CI 1.07-15.58), and unclear results for hysterectomy (RR 4.38, 95% CI 0.47-41.09) with the use of the condom-catheter or surgical glove balloon. One non-randomised study showed unclear effects on the composite outcome (RR 0.33, 95%CI 0.11-1.03) and hysterectomy (RR 0.49, 95%CI 0.04-5.38) after the inclusion of Bakri balloon. The second non-randomized study found unclear effects on the composite outcome (RR 0.95, 95%CI 0.32-2.81) and hysterectomy (RR 1.84, 95%CI 0.44-7.69) after the inclusion of Ebb or Bakri balloon. Conclusions: the effect of uterine tamponade devices for the management of atonic refractory PPH after vaginal delivery is unclear, as is the role of the type of device and the setting.

Peer review status:ACCEPTED

19 Nov 2020Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
27 Nov 2020Submission Checks Completed
27 Nov 2020Assigned to Editor
09 Dec 2020Reviewer(s) Assigned
22 Dec 2020Review(s) Completed, Editorial Evaluation Pending
27 Jan 2021Editorial Decision: Revise Major
29 Mar 20211st Revision Received
03 Apr 2021Assigned to Editor
03 Apr 2021Submission Checks Completed
03 Apr 2021Review(s) Completed, Editorial Evaluation Pending
13 Apr 2021Editorial Decision: Revise Minor
13 Apr 20212nd Revision Received
15 Apr 2021Submission Checks Completed
15 Apr 2021Assigned to Editor
15 Apr 2021Review(s) Completed, Editorial Evaluation Pending
16 Apr 2021Editorial Decision: Accept