Antibiotics during Intrauterine Balloon Tamponade Is Associated with a Reduction in Endometritis

Abstract

Objective To evaluate whether prophylactic antibiotics at the time of placement of an intrauterine balloon tamponade (IBT) is associated with a reduction in postpartum endometritis. Study Design Retrospective cohort study of patients who received an IBT from January 1, 2012, to December 12, 2016. Patients were included if the IBT remained in place at least 2 hours and excluded if chorioamnionitis was present. Patients who received prophylactic antibiotics at the time of IBT placement were compared with those who did not. Results A total of 149 subjects received an IBT; 36 were excluded due to early removal or chorioamnionitis. Of the remaining, 59 received prophylactic antibiotics and 54 did not. Baseline characteristics were similar between the groups except mode of delivery. The majority (65%) of those who did not receive prophylactic antibiotics had a cesarean delivery (p = 0.03). The overall incidence of endometritis was 15%. The incidence of endometritis was greater among those patients who did not receive prophylactic antibiotics compared with those who did (5 vs. 26%; p < 0.002; odds ratio [OR]: 6.53; 95% confidence interval [CI]: 1.76–24.25). This association remained after adjustment for mode of delivery and receiving group B Streptococcus antibiotics prior to delivery (adjusted OR: 5.9; 95% CI: 1.58–22.35). Conclusion Prophylactic antibiotics were associated with a reduction in postpartum endometritis among patients receiving an IBT.

Intrauterine Tamponade Balloon for Management of Severe Postpartum Haemorrhage: Does Early Insertion Change the Outcome? A Retrospective Study on Blood Loss

“…Wong et al did a retrospective cohort study and demonstrated that prophylactic antibiotics were associated with a reduction of postpartum endometritis. The overall incidence of endometritis was 5% in the group with prophylactic antibiotics vs. 26% in the group without [41]. Franklin-Dumon et al conducted a retrospective study to compare the incidence of endometritis between patients with PPH, with and without the use of IUTB.…”

Antibiotic Recommendations After Postpartum Uterine Exploration or Instrumentation

“…An Australian randomized clinical trial using the Bakri balloon as PPH prophylaxis for placenta previa following cesarean delivery utilized 1 g cefazolin and had a postpartum endometritis rate of 0% 57 . Another retrospective cohort study found the most common regimen for antibiotic prophylaxis for uterine balloon tamponade to be cefazolin 1 g every 8 hours, with patients receiving a median of 3 doses 58 …”

“…57 Another retrospective cohort study found the most common regimen for antibiotic prophylaxis for uterine balloon tamponade to be cefazolin 1 g every 8 hours, with patients receiving a median of 3 doses. 58 Although various antibiotic regimens have been studied, there is little official guidance from national or worldwide organizations. The main recommendation comes from the WHO.…”

Postpartum hemorrhage: prevention, diagnosis and non-surgical management

“…Antibiotic prophylaxis (cephalosporin) and maintenance dose oxytocin should be administered throughout the tamponade time. (6,22,23,(25)(26)(27) After the infusion, the evaluation of the tamponade test begins. If within 30 minutes of infusion the drainage shows less than 50 mL, the prediction of successful tamponade is considered positive.…”