Table 1. Summary of findings.

UBT: uterine balloon tamponade, PPH: postpartum-hemorrhage, EBL: estimated blood loss, ICD: International Code for Disease, ICU: intensive care unit, IIAL: internal iliac artery ligation

The table was made by the authors.

Authors	Key Findings/Summary	Limitations/Conclusions
Overton et al., 2023 [3]	4,791 patients from 91 studies demonstrated 85.9% efficacy in the resolution of hemorrhage with the use of UBT, with a major success in the setting of atony (87.1%). Vaginal birth registered more success (87.0%) as opposed to cesarean birth (81.7%).	This analysis was shown to be more successful in women that went through vaginal birth than cesarean. The use of UBT for managing hemorrhage should only be used if there’s adequate monitoring of the patient's clinical status after placement. Followed up with immediate access to surgical intervention.
Franke D et al., 2021 [6]	Uterine atony was significantly associated with postpartum hemorrhage (p = 0.048), a decrease in hemoglobin (p < 0.001), an increase in measured blood loss, and the need for blood transfusion.	Early detection of uterine atony is a major factor in the management of postpartum hemorrhage.
Likis FE et al., 2015 [7]	A retrospective cohort study evaluated 91 women with mean age = 33.3 ± 4.6, median parity = 0, range 0-3) undergoing treatment for severe PPH with estimated blood loss of ≥1500 ml within 24 hours after birth. PPH was due to atony in 41.8% of cases. They were treated with intravenous oxytocin (n=33 receiving oxytocin only) and other uterotonic agents (n = 16 receiving oxytocin plus other agents). PPH resolved without the need for additional procedures among the 49 women treated with oxytocin and other uterotonic agents. Uterine atony accounted for 26.5% of cases, while uterine rupture, coagulopathy, and retained placenta accounted for 42.9%.	Bleeding control was achieved without a need for further surgeries in 45 of 91 women receiving oxytocin alone or with other uterotonics. The study does not report analytic comparisons.
Liu C-N et al., 2021 [10]	PPH was observed in 532 mothers among the total population of 34,178 mothers. Abnormal placentation (53.8%) was primarily identified as a cause of PPH, while uterine atony without placental tissues accounted for 38.91% of the cases. The study demonstrated that uterine atony without other causes was lower than the observed prevalence of 70–80%. By contrast, abnormal placentation, which was a significant cause of PPH, was higher than the previously stated  prevalence of 10%.	Lack of data on vaginal deliveries and emergency cesarean sessions based on ICD codes.
Callaghan W et al., 2010 [11]	Uterine atony accounted for PPH increased to 26% between 1994 and 2006 from 2.3% (n = 85,954) to 2.9% (n = 124,708; p < 0.001).	Population-based surveillance data demonstrated an apparent increase in PPH caused by uterine atony. Clinical data are needed to understand the factors associated with this trend.
Dueckelmann A et al., 2023 [12]	A study assessed 78 patients with refractory PPH due to atonic bleeding. 60.3% received a chitosan-covered gauze tamponade, whereas 39.7% received a UBT. No significant difference was observed between either group. There was also no difference in the mean estimated blood loss (EBL) (2017 mL gauze; 1756 mL UBT; p = 0.225), admission to ICU, and hemoglobin levels. A controlled study with a larger sample size would be effective to demonstrate the efficacy of this method. This could be explored in low resource settings, as long as adequate monitoring is provided. A full analysis of cost effectiveness should also be assessed with the use of UBT.	Chitosan covered gauze is an excellent option for treating PPH as a result of atony or placental bed bleeding. It is equivalent to balloon tamponade. The study was limited by sample size and its design.
Maria I, 2020 [13]	A feasibility study evaluated the use of mini-sponge tamponade devices in nine patients. This device was made from trauma gauze and was described as successful in the placement and control of PPH. Safety and efficacy of this method in a larger prospective study should be explored. This should be in comparison with alternate methods.	More data will be required to evaluate the safety and efficacy of this technique.
Doumouchtsis et al., 2014 [14]	A systematic review evaluated 125 women who had been treated for postpartum hemorrhage by uterine compression sutures. They estimated that 91% of the women have normal menstrual cycles by six months after their compression procedure and that 75% of those who desired another pregnancy achieved conception. The results show that this technique does not alter subsequent fertility. Although the data on this are limited, it deserves to be explored more by further studies, with higher statistical power. A better research and information regarding fertility after this procedure, and its associated risks could relieve potential mothers of their worries regarding a new pregnancy.	Uterine surgical techniques for the management of severe PPH have no adverse effect on menstrual and fertility outcomes in most women. However, the number of studies and the quality of evidence available are limited.
Shahinoor et al., 2022 [15]	Forty-five patients from three different African countries participated in research implementing preventative strategies such as E-MOTIVE to reduce PH. This includes multidisciplinary simulation training, which improves team communication and collaboration to improve early detection of PH.	Inadequate training of healthcare providers, especially in developing countries, is a major contributor to the early detection and emergency treatment of PH.
Kayem G et al., 2011 [16]	A total of 211 women were treated with a uterine compression suture to control postpartum hemorrhage. The effectiveness rate was 75% (95% confidence interval (CI), 69–81), and the method of compression technique used (compress or multiple sutures, B-Lynch) showed no difference in the outcome of hysterectomy. This is a simple procedure that could be tried before any complex surgery with a shorter operating time. There’s the risk of intrauterine adhesions and scarring after this procedure. This possibilty has not yet been explored. It could be beneficial if assessed in future studies especially for women who desire another pregnancy.	This technique is majorly used in PPH cases caused by uterine atony and refractory to medical treatment.
Kaya B, 2017 [17]	Among 26 women with uterine atony, 12 had primary and 14 secondary procedures of IIAL. Following bleeding after a B-Lynch uterine compression procedure. There was a success rate  of 87% with this procedure. This is a difficult procedure that requires thorough knowledge of pelvic vascular anatomy and exposure. It can cause severe morbidity like iliac vein injury, gluteal claudication, and ligation of ureter. This should only be assessed in major surgeries.It should be advised that this procedure is not often performed as it requires obstetricians that have less experience in surgery.	It is important to propose second-line surgical treatment after failure of ligation or uterine compression sutures to stop PPH hemorrhage. This should be offered before performing a peripartum hysterectomy.
Sentilhes L, 2008 [18]	B-Lynch sutures controlled hemorrhage and avoidance of hysterectomy in 12 of 15 cases (80%) of women with PPH after cesarean deliveries despite vessel ligation. There is the risk of  uterine necrosis following B-Lynch suture, resulting in subsequent hysterectomy in a patient. It is important for future studies that sufficient data are collected on the patient population before employing this procedure as the first-line surgical treatment of PPH.	The B-Lynch technique has shown to be an effective procedure with a low morbidity in the control of severe PPH following a failure of vessel ligation.
Purwosunu et al. 2016 [19]	A preliminary study on vacuum-induced uterine tamponade demonstrated bleeding control in 10 patients who failed first-line PPH treatment following vaginal birth. They had an EBL of 600 to 1000 mL before placement of the device. Evacuation of 50 to 250 mL of blood and hemorrhage control was achieved in <2 minutes. A large-scale, prospective data will be needed to establish the safety and efficacy of this device in future.  The optimization of this device should also be explored further, as it can be assessed in terms of device efficacy, when used with compression sutures technique and uretonics. The cost of this device in comparison to other methods should also be put into consideration.	This investigation proposes that a device made to create vacuum-induced uterine tamponade may be a better alternative in the treatment of atonic postpartum hemorrhage. This device is contraindicated in women with abnormal uterine anatomy and intrauterine infection.
D’Alton et al. 2020 [20]	A successful treatment was observed in 94% (100/106, 95% CI 88-98%) of 106 participants that participated in a treatment with vacuum-induced tamponade. One hundred had successful bleeding control at a median of three minutes and a median EBL during treatment of 110 mL after vacuum connection. This device demonstrated a >90% success rate in the control of abnormal bleeding. This can be beneficial in future studies, as it can be incorporated in a common treatment goal, thereby improving  maternal recovery.	This method of hemorrhage control may provide a rapid and effective treatment option for postpartum hemorrhage, with the potential to prevent maternal morbidity and mortality. This device will be ineffective if cervical dilation is less than 3 cm.
Goffman et al. 2023 [21]	An observational study of 800 individuals (n = 530 vaginal births, n = 270 cesarean births) who were treated with an Intrauterine vacuum-induced hemorrhage control device, of whom 94.3% had uterine atony. A treatment success rate was recorded as 92.5% for vaginal births and 83.7% for cesarean births. The median indwelling time was 3.1 hours and 4.6 hours, respectively. Bleeding control was achieved in ≤5 minutes for 73.8% in the vaginal and 62.2% post cesarean.  There was no record of uterine perforations or deaths. In a highly structured controlled clinical trial that assesses data collection and patient management, arriving at similar conclusions will be unattainable. There would be difficulty in  ascertaining data such as blood loss volume and time of hemostasis in real-life treatment of PPH. This is because blood loss in this study was estimated and most likely underestimates the total amount of blood loss. The study was intended to assess use of the device; therefore, comparisons to future treatments would be futile.	This device is important in managing a life-threatening condition, and timely utilization may help improve obstetric hemorrhage outcomes.