Intrauterine balloon tamponade in the management of severe postpartum haemorrhage after vaginal delivery: Is the failure early predictable?

Postpartum haemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality world-wide. The arrival of intrauterine balloon devices has revolutionised PPH management. However, it seems interesting to know the situations of failure to improve the management. The objective is to define the factors related to failure of intrauterine balloon tamponade (IUBT) in women with a postpartum haemorrhage (PPH) after vaginal delivery, and especially blood loss after placement to avoid delaying management. Retrospective cohort study was conducted in 2 centers. All PPH after vaginal deliveries treated by IUBT were included. Two groups were defined (successes and failures) and compared. Failure was defined as the need of invasive procedure. Calculated area under receiver operating characteristic (ROC) curves and thresholds of bleeding at 10 min were also calculated for prediction of failure. 127 women were included. The overall success rate was 78.0 % (95 % CI 70.7-85.1 %). Blood loss at 10 min was factor prognostic of early IUBT failure. The ROC curve of blood loss at 10 min for prediction of failure of IUBT had an area under the curve of 0.876 (95 % CI 0.782-0.970). The predictive positive value of blood loss at 10 min were respectively 0.53, 0.8 and 0.94 for blood loss of 100, 200 and 250 mL. Physicians should be alerted if blood loss are more than 200 mL at 10 min after placement of IUBT and considered invasive procedure if more than 250 mL to avoid delaying management of PPH.

How reproducible are classical and new CT-pelvimetry measurements?

PURPOSE: The objective of this study was to assess the reliability and reproducibility of existing and new computed tomography (CT)-pelvimetry measurements. MATERIAL AND METHODS: A retrospective cohort study of 63 women with a mean age of 33.9±5.2 (SD) years (range: 19-49 years) was conducted. Classical pelvimetry measurements were collected including the obstetric conjugate (OC), median transverse diameter (MTD), and interspinous diameter (ISD). Additionally, we used multiplanar reconstruction (MPR) mode to define two oblique planes: inlet pelvic plane (IPP) and mid-pelvic plane (MPP) and measure new pelvic parameters, including anteroposterior (APD), transverse diameters and circumference of both IPP and MPP (inletAPD, inletMTD, inletCIRC and midAPD, ISD, midCIRC, respectively). The reproducibility (intra- and inter-observer) of our results were assessed. Multivariate analyses using principal component analysis and clustering methods were conducted to analyze the association between pelvimetry measurements and identify patient sub-groups. RESULTS: All linear measurements (OC, inletAPD, MTD, inletMTD, midAPD, and ISD) showed statistically "almost perfect" intra- and inter-observer correlation coefficients (range: 0.924-0.980). Circumferences (inletCIRC and midCIRC) showed statistically "almost perfect" intra- (range: 0.847-0.857) and inter-observer correlation coefficients (range: 0.923-0.957). The measurement of 6 pelvimetric parameters allowed determining three groups of pelvis size. CONCLUSION: New pelvic measurements have excellent reproducibility and are similar to the classical measurements, based on the MPR analysis of CT planes adjusted to the inner bony pelvis.