Intrauterine gauze or balloon tamponade for the management of postpartum hemorrhage due to uterine atony during maternal transportation

Aim: This study aimed to evaluate the effectiveness of intrauterine gauze or balloon tamponade for the management of postpartum hemorrhage due to uterine atony during maternal transportation from private clinics to higher-level facilities.Methods: A total of 1,428 patients were transported to the Department of Obstetrics, Juntendo University Shizuoka Hospital, between January 2008 and December 2019. Among these, 42 patients had postpartum hemorrhage due to uterine atony. Of the 42 patients, 29 (69.0%) were treated with intrauterine gauze or balloon tamponade before transportation (tamponade group); no intrauterine packing was performed in the remaining 13 (31.0%) (non-tamponade group). The primary outcome was the rate of critical obstetrical hemorrhage at hospital arrival. Secondary outcomes were blood loss before and after transportation, hemoglobin, platelets, fibrinogen, amount of blood transfusion, and rate of transfusion.Results: The rate of critical obstetrical hemorrhage was significantly lower in the tamponade group (34.5% (10/29)) compared to the non-tamponade group (76.9% (10/13)). Moreover, total blood loss during transportation and after hospital arrival was significantly lower in the tamponade group (487±331 g) compared to the non-tamponade group (1,199±1,012 g).Conclusion: Intrauterine gauze or balloon tamponade before transportation to higher-level facilities is effective for managing postpartum hemorrhage due to uterine atony.