{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T21:40:12Z","timestamp":1790804412378,"version":"4.1.0"},"reference-count":17,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Globally, 1 in 5 maternal deaths are attributable to major postpartum hemorrhage (PPH), despite widespread uterotonic use. Intrauterine tamponade is recommended as second\u2010line therapy for refractory atonic PPH. Uterine balloon tamponade (UBT) achieves hemostasis through intrauterine pressure. Conversely, the vacuum\u2010assisted hemorrhage\u2010control device (VHD) promotes uterine contraction through negative pressure. Limited data compare these modalities. We compared the clinical effectiveness of UBT and VHD in refractory atonic PPH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study was conducted at the National University Hospital in Singapore and included all women treated for primary PPH with either the UBT or VHD between January 2020 and September 2025, during which ROTEM\u2010guided transfusion and E\u2010MOTIVE\u2010aligned practices were implemented. The composite morbidity endpoint, comprising transfusion of \u22654\u2009units of packed red blood cells (PRBC), plasma or cryoprecipitate administration, examination under anesthesia, high dependency or intensive care unit admission, or device failure was compared between groups with logistic regression adjusted for placenta previa major and cesarean delivery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifty\u2010three women met inclusion criteria (33 UBT, 20 VHD). The composite morbidity outcome occurred less frequently with VHD than UBT (45.0% versus 75.8%; unadjusted OR 0.26, 95% CI 0.08\u20130.86,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03); after adjusting for placenta previa major and cesarean delivery, this difference was no longer statistically significant (adjusted OR 0.38, 95% CI 0.10\u20131.41,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.15). Baseline characteristics were similar except for higher rates of placenta previa (45.5% versus 5.0%) and cesarean delivery (78.8% versus 50.0%) in the UBT group. Median estimated blood loss at device insertion was comparable (1500\u2009mL). Among secondary outcomes, VHD was associated with lower median PRBC transfusion (1 vs. 2\u2009units,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.009), fewer women receiving \u22654 PRBC units (5.0% versus 36.4%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02), fewer plasma transfusions (5.0% versus 36.4%, p\u2009=\u20090.02), shorter device indwelling duration (10.1 versus 24.3\u2009h,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), shorter hospital stay (54 versus 72\u2009h,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007), and fewer high\u2010dependency admissions (45.0% versus 72.7%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The VHD demonstrated outcomes comparable to balloon tamponade in managing refractory atonic PPH, with lower transfusion requirements and shorter hospitalization. VHD may be a useful component of standardized PPH protocols incorporating the E\u2010MOTIVE bundle and ROTEM\u2010guided transfusion, warranting further evaluation in broader clinical settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aogs.70334","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T10:00:01Z","timestamp":1786010401000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Vacuum\u2010assisted hemorrhage control device versus uterine balloon tamponade for refractory atonic postpartum hemorrhage in a protocol\u2010driven care pathway\u2014A retrospective cohort study"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2368-8330","authenticated-orcid":false,"given":"Kelvin Z. X.","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology National University Health System  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0882-3040","authenticated-orcid":false,"given":"Calista L. S.","family":"Por","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine National University of Singapore  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tak Yein","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology National University Health System  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4095-3186","authenticated-orcid":false,"given":"Pradip","family":"Dashraath","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology National University Health System  Singapore Singapore"},{"name":"Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine National University of Singapore  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4931-1606","authenticated-orcid":false,"given":"Wei Wei","family":"Teo","sequence":"additional","affiliation":[{"name":"Department of Anesthesia National University Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"King","sequence":"additional","affiliation":[{"name":"Department of Anesthesia National University Hospital  Singapore Singapore"},{"name":"Department of Anesthesia, Yong Loo Lin School of Medicine National University of Singapore  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4163-5146","authenticated-orcid":false,"given":"Su Wei Bryan","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Anesthesia National University Hospital  Singapore Singapore"},{"name":"Department of Anesthesia, Yong Loo Lin School of Medicine National University of Singapore  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0589-2541","authenticated-orcid":false,"given":"Harshaana","family":"Ramlal","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology National University Health System  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Shen","sequence":"additional","affiliation":[{"name":"Biostatistics Unit, Department of Medicine National University of Singapore  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arijit","family":"Biswas","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology National University Health System  Singapore Singapore"},{"name":"Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine National University of Singapore  Singapore Singapore"},{"name":"Department of Obstetrics and Gynaecology National University Centre for Women and Children (NUWoC)  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1997-3107","authenticated-orcid":false,"given":"Ganesh","family":"Acharya","sequence":"additional","affiliation":[{"name":"Division of Obstetrics &amp; Gynecology, Department of Clinical Science, Intervention and Technology (CLINTEC) Karolinska Institutet, and Center for Fetal Medicine, Karolinska University Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabaratnam","family":"Arulkumaran","sequence":"additional","affiliation":[{"name":"City St George's University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahesh","family":"Choolani","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology National University Health System  Singapore Singapore"},{"name":"Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine National University of Singapore  Singapore Singapore"},{"name":"Department of Obstetrics and Gynaecology National University Centre for Women and Children (NUWoC)  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5973-9318","authenticated-orcid":false,"given":"Sarah W. L.","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology National University Health System  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanwpc.2021.100217"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31470-2"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(24)00560-6"},{"key":"e_1_2_13_5_1","unstructured":"World Health Organization.Trends in maternal mortality estimates 2000 to 2023: estimates by WHO UNICEF: UNFPA World Bank Group and UNDESA\/Population Division.2025."},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2303966"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/00016340802087660"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.16040"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000006024"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000004138"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/anr3.70028"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogc.2023.02.017"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2025.2537225"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000005770"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2023.08.015"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0134282"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2019.11.1287"},{"issue":"4","key":"e_1_2_13_18_1","doi-asserted-by":"crossref","first-page":"293.e1","DOI":"10.1016\/j.ajog.2019.11.1287","article-title":"Uterine balloon tamponade for the treatment of postpartum hemorrhage: a systematic review and meta\u2010analysis","volume":"222","author":"Suarez S","year":"2020","journal-title":"Am J Obstet Gynecol"}],"container-title":["Acta Obstetricia et Gynecologica Scandinavica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aogs.70334","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/aogs.70334","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aogs.70334","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T06:01:58Z","timestamp":1787205718000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/aogs.70334"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,6]]},"references-count":17,"alternative-id":["10.1111\/aogs.70334"],"URL":"https:\/\/doi.org\/10.1111\/aogs.70334","archive":["Portico"],"relation":{},"ISSN":["0001-6349","1600-0412"],"issn-type":[{"value":"0001-6349","type":"print"},{"value":"1600-0412","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,6]]},"assertion":[{"value":"2026-05-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"aogs.70334"}}