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Suction tube uterine tamponade versus uterine balloon tamponade for treatment of refractory postpartum hemorrhage: A randomized clinical feasibility trial. 2025

Mandisa Singata-Madliki, and Albaro J Nieto-Calvache, and Luisa F Rivera Torres, and Hazmath Abdul, and Joanne Batting, and Sylvia N Cebekhulu, and Lawrence Chauke, and Priya Soma-Pillay, and Susan Fawcus, and Logie Govender, and Busiwe Majeke, and Xolani Mbongozi, and Katrin Middleton, and Poovangela Naidoo, and Sanele Ndaba, and Trevi Spence, and Gaynor M Balie, and Angelica Monroy, and Monica Cantor, and G Justus Hofmeyr
Effective Care Research Unit, University of the Witwatersrand and Walter Sisulu University, East London, South Africa.

OBJECTIVE To compare low-cost "Suction Tube Uterine Tamponade" (STUT) treatment for refractory postpartum hemorrhage (PPH) with uterine balloon tamponade (UBT) using a randomized feasibility study. METHODS After verbal assent, we allocated participants with refractory PPH by randomly ordered envelopes to STUT or routine UBT at 10 hospitals in South Africa and one tertiary referral center in Colombia between January 10, 2020, and May 3, 2024. In the STUT group, we inserted a 24 FG Levin stomach tube into the uterine cavity and applied suction. The control group received standard UBT, mainly the Elavi free-flow balloon or the Bakri fixed volume balloon. There were fundamental differences between the South African and the Colombian sites, so the pre-specified analysis combined data from the two countries by meta-analysis. RESULTS We enrolled 59 participants. The rate of the primary outcome (blood loss >1000 mL or laparotomy or death) was 8/27 (30%) in the STUT group versus 14/27 (52%) in the UBT group (risk ratio [RR] 0.56, 95% confidence interval [CI] 0.30-1.05, P = 0.07). Per protocol analysis was 7/26 (27%) versus 15/28 (54%) (RR 0.49, 95% CI 0.25-0.96, P = 0.04). Reporting severe pain during the procedures was less frequent in the STUT group (RR 0.46, 95% CI 0.25-0.86, P = 0.01). Most secondary outcomes favored the STUT group, with low certainty. CONCLUSIONS STUT was experienced as less painful than UBT. Results were consistent with reported observational findings and one other randomized trial evidence of greater effectiveness for suction than balloon tamponade.

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