Analysis Of Intrauterine Balloon Tamponade For Severe Postpartum Hemorrhage

Purpose Analyze the risk factors of severe postpartum hemorrhage.Compare the clinical effects and evaluate the short-and long-term effects of different clinical interventions for severe postpartum hemorrhage.Provide evidence-based basis for early identification and appropriate therapy in high-risk pregnant women.MethodThis was a clinical control study.From January 2017 to September 2019,a total of 405 pregnant patients with deliveries in Zhongda Hospital affiliated to Southeast University,including 255 cases who had SPPH,were recruited.A total of 150 patients with non-severe postpartum hemorrhage were analyzed as controls,who were all singleton-gestation.According to the 24-hour postpartum blood loss,all patients were divided into three groups(A group:150cases<1000ml,B group:205 cases of 1000-1500 ml,and C group:34 cases≥1500ml)after 16 cases twin-gestation patients were excluded from 255 cases with SPPH.Analyze by orderly Logistic regression the clinical parameters of three groups of puerpera.There were 242 cases patients with SPPH after excluding 13 cases patients of uterine artery ligation and interventional embolization and hysterectomy from all 255 pregnant patients with SPPH.According to clinical interventions for severe postpartum hemorrhage,242 cases with SPPH were divided into four groups(intrauterine balloon group,46 cases;B-Lynch suture group,21 cases;intrauterine balloon+B-Lynch suture group,22 cases;drug group,153 cases).Analyze data of four groups and follow up puerpera and with intrauterine balloon,B-Lynch suture and intrauterine balloon+B-Lynch suture of severe postpartum hemorrhage.singleton-gestation and The SPSS22.0 statistical software was used to analyze the data.Outcomes1.Single factor analysis: there were statistically significant differences in the age,prepregnancy BMI,pre-delivery BMI,pregnancy associated with diabetes,placenta previa,delivery mode,neonatal weight among the three groups of different 24-hour postpartum blood loss(P<0.05).2.Orderly Logistic regression showed that advanced age(≥35years),pregnancy associated with diabetes,placenta previa,cesarean section and macrocephaly(≥4000g)were risk factors for SPPH,and there were no statistical differences in gravidity(≥3),multiparity,obesity(BMI≥30kg/m~2),weight gain during pregnancy,scar uterus,and assisted reproduction(P>0.05).3.Comparison between intrauterine balloon group and drug group: there were no statistical differences in age,parity,pre-pregnancy BMI,pre-delivery BMI,pregnancy assmociated with diabetes,scar uterus,assisted reproductive technology,neonatal weight and 24-hour postpartum blood loss between the intrauterine balloon group and the drug group(P>0.05),and there were statistical differences in the number of gravidity,gestational weeks,incidence of placenta previa and cesarean section rate between two groups(P<0.05).4.Comparison of three operations: There were significant differences in age,gravidity,parity,gestational weeks,placenta previa and neonatal weight between B-Lynch suture group and intrauterine balloon group(P<0.05).There were no statistical differences in pre-pregnancy BMI,pre-delivery BMI,pregnancy associated with diabetes,scar uterus,assisted reproductive technology,delivery mode,24-hour postpartum blood loss between B-Lynch suture group and intrauterine balloon group(P>0.05).There were no statistical differences in all factors between intrauterine balloon+B-Lynch suture groupand intrauterine balloon group(P>0.05).5 Follow-up: there were no statistically significant differences in B-ultrasound,lochia and puerperal morbidity,breast,return of menses among groups of intrauterine balloon,B-Lynch suture group and intrauterine balloon+B-Lynch suture group(P>0.05).There were statistical differences in menstrual volume reduction between B-Lynch suture group and intrauterine balloon group in menstrual cycle between intrauterine balloon group and intrauterine balloon+B-Lynch suture group(P<0.05).Conclusion1.Advanced age(≥35 years),pregnancy associated with diabetes,placenta previa,cesarean section and macrocephaly(≥4000g)are independent risk factors for SPPH.2.On the basis of drug,intrauterine balloon is more effective for patients of SPPH with more gravidity,smaller weeks,placenta previa and cesarean delivery.3.There was no significant difference in the efficacy for severe postpartum hemorrhage among intrauterine balloon,B-Lynch suture and intrauterine balloon+B-Lynch suture.4.There were no significant differences in puerperal morbidity,breast,B-ultrasound,lochia,,and return of menses among groups of intrauterine balloon,B-Lynch suture and B-Lynch suture+intrauterine balloon.Intrauterine balloon tam Ponade for SPPH appeared make no significant effects on subsequent menstrual.