| Objective:To investigate the hemostatic effect,prognosis,timing of hemostasis,indications,filling methods and reasons for hemostasis failure in postpartum hemorrhage with intrauterine balloon tamponade and uterine gauze packing.Method:Retrospective analysis of the maternal medical records of the Jiangxi Provincial Maternal and Child Health Hospital from January 2016 to January 2018,due to postpartum hemorrhage using uterine tamponade to stop bleeding,collected 207 cases of uterine balloon packing medical records,uterine gauze packing 85 medical records.According to the mode of delivery,there were 112 cases of balloon vaginal delivery group,30 cases of gauze vaginal delivery group,95 cases of balloon cesarean section,and 55 cases of gauze cesarean section.According to the mode of delivery,compare the volume of pre-filling blood in the balloon vaginal delivery group,the gauze delivery group,the balloon cesarean section and the gauze cesarean section,the amount of blood loss after 12 hours of filling,the blood transfusion volume,the success rate of hemostasis,Rate of puerperal infection,hysterectomy rate,postoperative hospital stay.According to the hemostasis method,the two methods of delivery,the filling method,the hemostasis success rate in different bleeding stages,the hemostasis success rate and the composition ratio of different postpartum hemorrhages were analyzed.Summarize the factors of hemostasis failure and subsequent treatment measures of two kinds of uterine tamponade.Results:Comparison of bleeding volume before tamponade:balloon vaginal delivery group(755.49±220.23)ml,gauze vaginal delivery group(672.33±200.18)ml;balloon cesarean section group(986.65±376.19)ml,gauze cesarean section group(1085.64±336.23)ml,the difference was not statistically significant(t=1.871,P>0.05;t=1.662,P>0.05).Comparison of blood loss after 12h filling:balloon vaginal delivery group(86.49±59.16)ml,gauze vaginal delivery group(75.45±50.53)ml;balloon cesarean section(89.40±71.82)ml,gauze cesarean section There was no significant difference in the group(95.38±67.01)ml(t=1.001,P>0.05;t=0.498,P>0.05).Comparison of blood transfusion:balloon vaginal delivery group(1.68±1.44)U,gauze vaginal delivery group(1.33±1.01)U;balloon cesarean section(2.43±1.33)U,gauze cesarean section(2.75±1.38)U,the difference was not statistically significant(t=1.530,P>0.05;t=1.372,P>0.05).The success rate of hemostasis was92.86%in the vaginal delivery group,96.67%in the vaginal delivery group,95.79%in the cesarean section,and 92.73%in the cesarean section.The difference was not statistically significant(?~2=0.578,P>0.05;?~2=0.647,P>0.05).Comparison of hysteric-tomy rates:2.68%in the balloon vaginal delivery group,0%in the vaginal delivery group;3.16%in the balloon cesarean section,and 1.82%in the cesarean section.The difference was not statistically significant(Fisher exact probability method,P>0.05;?~2=0.241,P>0.05).Comparison of puerperal infection rate:2.68%in the balloon vaginal delivery group,20%in the vaginal delivery group;2.11%in the balloon cesarean section,21.82%in the cesarean section.The difference was statistically significant(?~2=11.959,P<0.05;?~2=15.996,P<0.05).Comparison of postoperative hospital stay days:balloon vaginal delivery group(3.51±0.54)d,gauze vaginal delivery group(3.33±0.61)d;balloon cesarean section(4.30±0.59)d,gauze cesarean section(4.33±0.55)d,the difference was not statistically significant(t=1.442,P>0.05;t=0.331,P>0.05).The hemostasis success rate of blood flow before filling was 500~1000ml,1000~1500ml and>1500ml:the balloon was 94.67%,91.84%,62.5%,and the gauze was 100%,95.24%and 66.67%respectively.The hemostasis success rates of the three hemostasis stages of the two kinds of uterine tamponade were compared,and the difference was statistically significant(?~2=11.715,P<0.05;?~2=19.400,P<0.05).There was a statistically significant difference in the success rate of hemostasis between the two groups:bleeding volume>1500ml and500~1000ml,1000~1500ml(P<0.05).The proportion of vaginal delivery and cesarean section in balloon tamponade was 54.11%and 45.89%,respectively.The proportion of transvaginal and transuterine placement was 96.62%and 3.38%,respectively;the filling of vaginal delivery and caesarean section by gauze filling The proportions were 35.29%and64.71%,respectively.The proportions of transvaginal and transuterine placement were 35.29%and 64.71%,respectively.Intrauterine tamponade is mainly used for postpartum hemorrhage of uterine contraction,placental factors and coagulopathy:the corresponding hemostasis success rate of the balloon is 93.71%,95%,62.5%,respectively,and the corresponding composition ratio is 76.81%,19.32%,3.87%,respectively.the success rate of hemostasis corresponding to the gauze was:96.67%,94.34%,50%,and the corresponding composition ratios were 35.29%,62.35%,and2.35%,respectively.The main factors of uterine tamponade for hemostasis failure are refractory uterine atony,hemorrhagic shock,and abnormal coagulation function.In addition to the above factors,the balloon also has the amount of water injection and improper placement.Conclusions:(1)When the amount of bleeding is>1500ml,the effect of hemostasis of the two kinds of uterine tamponade is decreased.Clinically,uterine cavity packing should be used in the early stage of postpartum hemorrhage.(2)Uterine gauze packing has a significantly higher proportion of puerperal infection than Uterine balloon tamponade.(3)Insufficient water injection and improper placement of the balloon are possible reasons for its failure.(4)Uterine balloon tamponade and Uterine gauze packing have their own advantages,each with limitations.Clinically,according to the conditions of medical institutions,the specific conditions of the mother and the operator's proficiency in the filling technique,the appropriate hemostasis program should be selected. |
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