Top 10 for 2021: #8 | Vacuum-Induced Uterine Tamponade Device for Postpartum Hemorrhage

Top 10 for 2021: #8 | Vacuum-Induced Uterine Tamponade Device for Postpartum Hemorrhage

The joy of becoming a mother can take an unexpected turn with the unpredictable childbirth complication. Postpartum hemorrhage or PPH, occurs when the uterus fails to contract to stop the bleeding vessels where the placenta was attached inside the body. This most common cause of PPH is called uterine atony, and leads to continued bleeding.

To stop the bleeding, mothers experiencing PPH may require blood transfusions, long, uncomfortable procedures, or even an emergency hysterectomy, resulting in the loss of fertility. Although the non-surgical use of a balloon to compress bleeding inside the uterus, known as balloon tamponade, has a high success rate, there's a new advancement in the PPH arena.

Known as vacuum-induced uterine tamponade, this procedure works more like a woman's body. A device is inserted into the uterus where gentle suction causes it to contract and shrink inside, effectively stopping the bleeding. While the new method is still finding its place in the OB workflow, clinical trials found it controlled bleeding within two minutes in all women tested. As a low tech solution, potentially translatable to developing countries with low resource availability, vacuum-induced uterine tamponade devices are showing promise to new mothers around the world.

William Morris, MD:
Hi, this is Dr. William Morris discussing the #8 Medical Innovation for 2021, ‘Vacuum-Induced Uterine Tamponade Device for Postpartum Hemorrhage.’ Joined with me is expert Dr. Edward Chien, Department Chair of Obstetrics and Gynecology at Cleveland Clinic. Dr. Chien, tell us a little bit more about this procedure and why it is so innovative.

Edward Chien, MD:
The vacuum-induced hemorrhage device is actually a new concept that was recently tested out internationally in a few small centers, and now just completed a clinical trial in the US involving 12 centers. It is actually a totally new approach to dealing with postpartum hemorrhage secondary to uterine atony, or the failure for the uterus to contract. Postpartum hemorrhage is the leading cause for maternal mortality in the world. It also leads to significant morbidities, such as acute respiratory distress syndrome, disseminated intra coagulation, shock, renal failure, and even infertility. It's also the leading cause of severe morbidity in the US and around the turn of this century, the rate of postpartum hemorrhage actually increased over 26%.

The current treatments for postpartum hemorrhage include active management or preventative treatments such as the use of oxytocin right after delivery, uterine massage, etc. Then the next treatment involves medications that cause the uterus to contract. The third-line treatment has been different devices, pretty much balloon tamponade devices that actually go in the uterus and are expanded to cause compression of the uterus so the uterine vessels stop bleeding.

The vacuum-induced hemorrhage control device is different in that it also goes into the uterus, but actually uses vacuum suction to cause the uterus to collapse down upon itself. That collapse then causes the muscle of the uterus to compress the vessels within the uterus to prevent bleeding. So it's much more physiologic instead of expanding out and pushing against the walls, it causes the uterus to collapse and contract and close off the vessels, which would happen normally after birth. So, it's a totally different approach to the control of hemorrhage within the uterus from failure to contract.

William Morris, MD:
In closing, Dr. Chien, do you see this becoming the gold standard?

Edward Chien, MD:
I think this is going to take, or replace, the use of the balloon compression devices for control of hemorrhage. The recent study that was published in Obstetrics and Gynecology showed that it actually had a higher rate of efficacy than the balloon tamponade in general, and also seemed to work much quicker. Within a few minutes, you've got control of hemorrhage when it was effective.

William Morris, MD:
Well, thank you so much Dr. Chien for being with us to share this important breakthrough device and the impact it can have for these patients.

Edward Chien, MD:
Thank you very much.
 
To read more about #8, click here. To watch the full one-on-one interview with Drs. Morris and Chien, click here.
 

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