首页> 外文期刊>Acta Obstetricia et Gynecologica Scandinavica: Official Publication of the Nordisk Forening for Obstetrik och Gynekologi >Comparison of outcome between intrauterine balloon tamponade and uterine artery embolization in the management of persistent postpartum hemorrhage: A propensity score‐matched cohort study
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Comparison of outcome between intrauterine balloon tamponade and uterine artery embolization in the management of persistent postpartum hemorrhage: A propensity score‐matched cohort study

机译:宫廷球囊局局局长与子宫动脉栓塞在持久性产后出血中的结果比较:倾向分数匹配队列研究

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Abstract Introduction The aim of this study was to compare the outcomes of women who were initially managed by intrauterine balloon tamponade or uterine artery embolization because of persistent postpartum hemorrhage demanding an immediate intervention to control bleeding. Material and methods Propensity score‐matched cohort study including women who had intrauterine balloon tamponade or uterine artery embolization as initial management strategy to control persistent postpartum hemorrhage, that is, refractory to first‐line therapy combined with at least one uterotonic agent. The primary outcome measure was a composite of peripartum hysterectomy and/or maternal mortality. Secondary outcomes measures were total volume of blood loss and total number of packed red blood cells transfused. Results Our 1:1 propensity score‐matched cohort comprised of 50 women who had intrauterine balloon tamponade and 50 women who underwent uterine artery embolization at a blood loss between 1000 and 7000?mL. There was no statistically significant difference in the hysterectomy risk between the two groups (n?=?6 in each group, odds ratio [OR] 1.00, 95% confidence interval [CI] .30‐3.34), in total volume of blood loss (median 4500?mL, interquartile range [IQR] 3600‐5400) for balloon vs 4000?mL (IQR 3250‐5000) for embolization, P ?=?0.382) or in total units of packed red blood cells transfused (median 7 (IQR 5‐10) for balloon vs 6 [IQR 4‐9] for embolization, P ?=?0.319). Fifteen women (30%) who were initially managed by an intrauterine balloon still underwent uterine artery embolization, of whom one had an embolization‐related thrombo‐embolic event. Maternal mortality occurred in neither of the intervention groups. Conclusions No difference in the risk of peripartum hysterectomy and/or maternal death was observed between women who had intrauterine balloon tamponade and women who underwent uterine artery embolization as an initial management for persistent postpartum hemorrhage. Although this study was underpowered to demonstrate equivalence, our study design provides a framework for future research in which intrauterine balloon tamponade may prove to be a suitable intervention of first choice in the management of persistent postpartum hemorrhage.
机译:摘要引言本研究的目的是比较最初由宫内球囊局局局或子宫动脉栓塞的妇女的结果,因为持续的产后出血要求立即干预措施来控制出血。材料和方法倾向分数匹配队列研究包括宫内球囊局局局局或子宫动脉栓塞作为初始管理策略,以控制持续的产后出血,即难以与至少一种外洛旋转剂结合的。主要结果措施是Peripartum子宫切除术和/或母体死亡率的复合物。二次结果措施均为输出的填充红细胞总量的总体积。结果我们的1:1倾向分数匹配的队列组成,由50名患有宫内球囊铺纳村庄和50名患有子宫动脉栓塞的50名妇女,在1000到7000?ml之间的血液损失。两组之间的子宫切除术风险没有统计学显着差异(每组N?=Δ6,赔率比[或] 1.00,95%置信区间[CI] .30-3.34),血液损失总量(中位数4500?ml,四分位数[IQR] 3600-5400)用于球囊与4000?ml(IQR 3250-5000)用于栓塞,p?= 0.382)或包装红细胞的总单位转移(中位数7( IQR 5-10)对于气球与6 [IQR 4-9]进行栓塞,P?= 0.319)。最初被宫内气球仍然由宫内气球管理的十五名女性(30%)仍然接受子宫动脉栓塞,其中一个人具有栓塞相关的血栓栓塞事件。孕产妇死亡中的干预群体都没有发生。结论宫内节球菌局局局局局长的妇女与患有子宫内动脉栓塞的女性的妇女患者患有植入子宫内切除术和/或孕产妇死亡的风险差异是持续产后出血的初步管理。虽然这项研究受到了展示了等价的动力,但我们的研究设计为未来的研究提供了一个框架,其中宫内球囊局局局长可能被证明是在持久的产后出血管理中成为一个合适的干预。

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