Intrauterine balloon tamponade versus uterine gauze packing for postpartum hemorrhage: A systematic review and meta‐analysis

BACKGROUND: Intrauterine balloon tamponade (IUBT) and uterine gauze packing (UGP) are commonly used to manage postpartum hemorrhage (PPH) that is unresponsive to first-line therapies. OBJECTIVE: This study compares the efficacy and safety of the IUBT and UGP in the management of PPH. METHOD: We searched the Cochrane Central Register of Controlled Trials in the Cochrane Library. MEDLINE and Embase databases from their inception to June 2024. We included randomized controlled trials (RCTs) that compared the IUBT to the UGP for the management of PPH. The primary outcomes were maternal mortality and blood loss. The secondary outcomes included blood transfusion, additional interventions, organ injury, and infection. We assessed the risk of bias for each outcome reported by the included studies. Meta-analysis was performed using random-effects models. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: Four trials involving 577 patients were included. Moderate-certainty evidence revealed no difference in mortality rates. IUBT might reduce blood loss volume (mean difference -276.2 mL, 95% confidence interval [CI] -563.0 to 10.6; low certainty) and transfusion (very low certainty) compared to UGP. IUBT might increase the need for additional interventions, but the evidence for this is very uncertain (risk ratio [RR] 2.57, 95% CI 0.89-7.40; very low certainty). IUBT likely reduces organ injury (RR 0.65, 95% CI 0.45-0.95) and infection (RR 0.47, 95% CI 0.38-0.59) compared to UGP (moderate certainty). CONCLUSION: The IUBT might reduce blood loss, transfusion, and complications in PPH compared to UGP, although the certainty of evidence is low. Larger, high-quality RCTs are required.