Balloon tamponade use in postpartum hemorrhage due to uterine atony: a retrospective study

OBJECTIVES: To investigate the influence of technical and clinical variations in uterine balloon tamponade (UBT) procedures on postpartum blood loss and maternal outcomes in women of postpartum hemorrhage (PPH) due to uterine atony. METHODS: This retrospective cross-sectional study was conducted on 63 patients who underwent UBT for atonic PPH between January 2020 and March 2025. Data collected included demographic characteristics, uterine balloon inflation volume, timing and duration of insertion, and maternal outcomes. The primary outcomes were success of UBT and occurrence of composite adverse maternal outcomes (CAMO). ROC analysis was used to identify optimal threshold values for procedural variables. RESULTS: UBT successfully controlled hemorrhage in 74.6 % of women. CAMO occurred in 17.5 % of patients. Severe PPH was observed in 60.3 % of women and was significantly associated with higher maternal shock index, increased transfusion requirements, and longer ICU stays. A delay of ≥45 min from delivery to UBT insertion was strongly associated with increased blood loss and higher CAMO incidence (AUC 0.858, p<0.001). Though not independently indicative of adverse outcomes, balloon volumes greater than 232.5 mL were associated with increased estimated blood loss (p=0.021). Duration of balloon retention and deflation timing had no significant impact on clinical outcomes. CONCLUSIONS: UBT is an effective intervention for controlling PPH secondary to uterine atony. Early application, within 45 min postpartum, is critical in reducing blood loss and maternal morbidity. Inflation volume may reflect bleeding severity but does not correlate with adverse outcomes. Findings support prompt and standardized application of UBT in PPH protocols.