Journal article

Effectiveness of uterine tamponade devices for refractory postpartum haemorrhage after vaginal birth: a systematic review

Research Areas

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Publication Details

Author list: V Pingray, M Widmer, A Ciapponi, GJ Hofmeyr, C Deneux, M Gülmezoglu, K Bloemenkamp, OT Oladapo, D Comandé, A Bardach, P Vázquez, G Cormick, F Althabe

Publisher: Wiley

Publication year: 2021

Journal: An International Journal of Obstetrics and Gynaecology

Journal acronym: BJOG

Volume number: 128

Issue number: 11

Start page: 1732

End page: 1743

Number of pages: 12

ISSN: 1470-0328

eISSN: 1471-0528

Languages: English


To evaluate uterine tamponade devices’ effectiveness for atonic refractory postpartum haemorrhage (PPH) after vaginal birth and the effect of including them in institutional protocols.

Search strategy

PubMed, EMBASE, CINAHL, LILACS, POPLINE, from inception to January 2021.

Study selection

Randomised and non-randomised comparative studies.


Composite outcome including surgical interventions (artery ligations, compressive sutures or hysterectomy) or maternal death, and hysterectomy.


All included studies were at high risk of bias. The certainty of the evidence was rated as very low to low. One randomised study measured the effect of the condom-catheter balloon compared with standard care and found unclear results for the composite outcome (relative risk [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 uterine balloon tamponade in institutional protocols. A stepped wedge cluster randomised controlled trial 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 the Bakri balloon. The second non-randomised 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.


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.

Tweetable abstract

Unclear effects of uterine tamponade devices and their inclusion in institutional protocols for atonic refractory PPH after vaginal delivery.


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Last updated on 2021-02-12 at 16:33