{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T23:56:45Z","timestamp":1790553405803,"version":"4.1.0"},"reference-count":41,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T00:00:00Z","timestamp":1763683200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T00:00:00Z","timestamp":1763683200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100016195","name":"United Nations Development Programme","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100016195","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The role of uterine gauze packing in treating refractory postpartum haemorrhage (PPH) is uncertain given limited evidence of benefit and possible harms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the safety and effectiveness of uterine packing using plain gauze or gauze impregnated with haemostatic agent(s) for treating refractory PPH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Search Strategy<\/jats:title>\n                    <jats:p>We searched MEDLINE, Embase, Emcare, Web of Science, CINAHL and CENTRAL from inception through March 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Selection Criteria<\/jats:title>\n                    <jats:p>Randomised controlled trials (RCTs) and non\u2010randomised controlled studies of intervention (NRSIs) evaluating uterine packing using plain gauze or gauze impregnated with haemostatic agents, compared with usual care or other interventions, for women with refractory PPH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Collection and Analysis<\/jats:title>\n                    <jats:p>We included one RCT (204 women) and six NRSIs (814 women). We presented findings from the RCT in a forest plot and conducted random\u2010effects meta\u2010analyses for NRSIs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Results<\/jats:title>\n                    <jats:p>\n                      Three comparisons had data: plain gauze versus balloon tamponade; gauze impregnated with haemostatic agents versus balloon tamponade; and plain gauze versus uterine artery ligation\/embolisation. From the RCT, uterine packing with plain gauze may not reduce the need for additional surgical\/radiological intervention (relative risk (RR) 1.29, 95% CI 0.50\u20133.32) or blood transfusion (RR 0.97, 95% CI 0.67\u20131.41;\n                      <jats:italic>low certainty evidence<\/jats:italic>\n                      ). Moderate\u2010certainty evidence indicates that for women with refractory PPH, uterine packing with plain gauze probably increases postpartum anaemia (&lt;\u200911\u2009g\/dL) (RR 1.27, 95% CI 1.07\u20131.51) and maternal fever &gt;\u200938\u00b0C (RR 2.40, 95% CI 1.21\u20134.76), compared to balloon tamponade. From NRSIs, evidence is very uncertain about the effects of uterine packing with plain gauze or gauze impregnated with haemostatic agents on all outcomes (\n                      <jats:italic>very low certainty evidence<\/jats:italic>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>There are no clear benefits of uterine packing with plain gauze or gauze impregnated with haemostatic agents for treating refractory PPH, and the risk of postpartum anaemia and maternal fever is probably increased compared to standard care. Prospective well\u2010controlled trials are needed to evaluate the effects of uterine packing and its role in treating refractory PPH.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1471-0528.70091","type":"journal-article","created":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T10:01:28Z","timestamp":1763719288000},"page":"579-589","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Safety and Effectiveness of Uterine Gauze Packing for Refractory Postpartum Haemorrhage: A Systematic Review\u00a0and Meta\u2010Analysis"],"prefix":"10.1111","volume":"133","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4164-3702","authenticated-orcid":false,"given":"Maureen","family":"Makama","sequence":"first","affiliation":[{"name":"Women's, Children's and Adolescents' Health Program Burnet Institute  Melbourne Australia"},{"name":"School of Public Health and Preventive Medicine Monash University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicia","family":"Ferguson","sequence":"additional","affiliation":[{"name":"Women's, Children's and Adolescents' Health Program Burnet Institute  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mairead","family":"Connolly","sequence":"additional","affiliation":[{"name":"Women's, Children's and Adolescents' Health Program Burnet Institute  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Boudova","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Maternal, Fetal Medicine Thomas Jefferson University  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samia","family":"Aziz","sequence":"additional","affiliation":[{"name":"Women's, Children's and Adolescents' Health Program Burnet Institute  Melbourne Australia"},{"name":"School of Public Health and Preventive Medicine Monash University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorena","family":"Romero","sequence":"additional","affiliation":[{"name":"The Ian Potter Library Alfred Health  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua P.","family":"Vogel","sequence":"additional","affiliation":[{"name":"Women's, Children's and Adolescents' Health Program Burnet Institute  Melbourne Australia"},{"name":"School of Public Health and Preventive Medicine Monash University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,21]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1513247"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(24)00560-6"},{"key":"e_1_2_10_4_1","unstructured":"World Health Organization \u201cA Roadmap to Combat Postpartum Haemorrhage Between 2023 and 2030 \u201d(World Health Organization 2023)."},{"key":"e_1_2_10_5_1","unstructured":"\u201cWHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage \u201d(Geneva: World Health Organization 2012)."},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2303966"},{"key":"e_1_2_10_7_1","unstructured":"\u201cWHO Recommendation on Tranexamic Acid for the Treatment of Postpartum Haemorrhage \u201d(2017)."},{"issue":"11","key":"e_1_2_10_8_1","article-title":"Uterotonic Agents for First\u2010Line Treatment of Postpartum Haemorrhage: A Network Meta\u2010Analysis","volume":"11","author":"Parry Smith W. 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