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The certainty of the evidence was rated as very low to low. One randomised study measured the effect of the condom\u2010catheter balloon compared with standard care and found unclear results for the composite outcome (relative risk [RR] 2.33, 95% CI 0.76\u20137.14) and hysterectomy (RR 4.14, 95% CI 0.48\u201335.93). Three comparative studies assessed the effect of including uterine balloon tamponade in institutional protocols. A stepped wedge cluster randomised controlled trial suggested an increase in the composite outcome (RR 4.08, 95% CI 1.07\u201315.58) and unclear results for hysterectomy (RR 4.38, 95% CI 0.47\u201341.09) with the use of the condom\u2010catheter or surgical glove balloon. One non\u2010randomised study showed unclear effects on the composite outcome (RR 0.33, 95% CI 0.11\u20131.03) and hysterectomy (RR 0.49, 95% CI 0.04\u20135.38) after the inclusion of the Bakri balloon. The second non\u2010randomised study found unclear effects on the composite outcome (RR 0.95, 95% CI 0.32\u20132.81) and hysterectomy (RR 1.84, 95% CI 0.44\u20137.69) after the inclusion of Ebb or Bakri balloon.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The effect of uterine tamponade devices for the management of atonic refractory PPH after vaginal delivery is unclear, as is the role of the type of device and the setting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Unclear effects of uterine tamponade devices and their inclusion in institutional protocols for atonic refractory PPH after vaginal delivery.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.16819","type":"journal-article","created":{"date-parts":[[2021,6,24]],"date-time":"2021-06-24T13:00:10Z","timestamp":1624539610000},"page":"1732-1743","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Effectiveness of uterine tamponade devices for refractory postpartum haemorrhage after vaginal birth: a systematic review"],"prefix":"10.1111","volume":"128","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7889-2825","authenticated-orcid":false,"given":"V","family":"Pingray","sequence":"first","affiliation":[{"name":"Instituto de Efectividad Cl\u00ednica y Sanitaria (IECS\u2010CONICET) Buenos Aires 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