Perinatology.  2016 Dec;27(4):236-243. 10.14734/PN.2016.27.4.236.

Efficacy of Bakri Balloon Tamponade in Massive Postpartum Hemorrhage: A Series of 57 Cases

• Kwon HY
• Kim YH
• Park YW
• Kwon JY

• KMID: 2367035
• DOI: http://doi.org/10.14734/PN.2016.27.4.236

Abstract

PURPOSE
To evaluate the efficacy of intrauterine Bakri balloon tamponade as a management of massive postpartum hemorrhage (PPH).
METHODS
Retrospective study including women who underwent intrauterine Bakri balloon tamponade for massive PPH between April 2010 and July 2015 was conducted. Massive PPH was defined as estimated blood loss exceeding 1,500 mL. Bakri balloon was inserted into uterus if women had PPH despite medical treatment after vaginal delivery or cesarean section. The balloon was inflated with sterile saline and removed after 12-24 hours. Failure was defined as needing another procedure for hemorrhage control. Demographic, obstetric and specific factors in regard to the Bakri balloon use were recorded. The successful rate of hemostasis by Bakri balloon was evaluated.
RESULTS
Among 138 women with PPH managed Bakri balloon insertion, 57 patients were diagnosed with massive PPH. The most common cause of massive PPH was placenta previa without accreta (54.4%), uterine atony (33.3%), placenta previa with accreta (10.5%) and placenta accreta (1.8%). The mean estimated blood loss was 2279.0 mL (range, 1,500-6,500 mL). The rate of successful control of massive PPH after Bakri balloon placement was 82.5%. From the cases of 57 patients, 10 patients needed additional procedures; five required uterine artery embolization and five underwent cesarean hysterectomy. No short-term complications or maternal death were observed after Bakri balloon insertion.
CONCLUSION
Bakri balloon tamponade is an effective, simple and quick approach in the treatment of massive PPH and it is useful as complementary management for earning time for another procedure.

Keyword

Bakri balloon; Massive postpartum hemorrhage; Intrauterine tamponade

MeSH Terms

Balloon Occlusion*
Cesarean Section
Female
Hemorrhage
Hemostasis
Humans
Hysterectomy
Maternal Death
Placenta Accreta
Placenta Previa
Postpartum Hemorrhage*
Postpartum Period*
Pregnancy
Retrospective Studies
Uterine Artery Embolization
Uterine Inertia
Uterus

Reference

1. Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van look PF. WHO analysis of causes of maternal death: systematic review. Lancet. 2006; 367:1066–1074.

2. Bonnar J. Massive obstetric hemorrhage. Baillieres Best Pract Res Clin Obstet Gynaecol. 2000; 14:1–18.

3. Condous GS, Arulkumaran S. Medical and conservative surgical management of postpartum hemorrhage. J Obstet Gynaecol Can. 2003; 25:931–936.

4. Dabelea V, Schultze PM, McDuffie RS. Intrauterine balloon tamponade in the management of postpartum hemorrhage. Am J Perinatol. 2007; 24:359–364.

5. Seror J, Allouche C, Elhaik S. Use of Sengstaken-Blakemore tube in massive postpartum hemorrhage: a series of 17 cases. Acta Obstet Gynecol Scand. 2005; 84:660–664.

6. Keriakos R, Mukhopadhyay A. The use of the Rusch balloon for management of severe postpartum haemorrhage. J Obstet Gynaecol. 2006; 26:335–338.

7. Akhter S, Begum MR, Kabir Z, Rashid M, Laila TR, Zabeen F. Use of a condom to control massive postpartum hemorrhage. MedGenMed. 2003; 5:38–43.

8. Bakri YN, Amri A, Abdul Jabbar F. Tamponade-balloon for obstetrical bleeding. Int J Gynaecol Obstet. 2001; 74:139–142.

9. Hockenberry MJ, Wilson D. Wong's Essentials of Pediatric Nursing. 9th ed. St Louis: Elsevier Inc;2013. p. 149–150.

10. Knight M, Callaghan WM, Berg C, Alexander S, Bouvier-Colle M-H, Ford JB, et al. Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group. BMC Pregnancy Childbirth. 2009; 9:55.

11. Cahn LL, Lo TK, Lau WL, Lau S, Law B, Tsang HH, Leung WC. Use of second-line therapies for management of massive primary postpartum hemorrhage. Int J Gynaecol Obstet. 2013; 122:238–243.

12. Majumdar A, Saleh S, Davis M, Hassan I, Thompson PJ. Use of balloon catheter tamponade for massive postpartum haemorrhage. J Obstet Gynaecol. 2010; 30:586–593.

13. Ferrazzani S, Iadarola R, Perrelli A, Botta A, Moresi S, Salvi S, et al. Use of an intrauterine inflated catheter balloon in massive post-partum hemorrhage: a series of 52 cases. J Obstet Gynaecol Res. 2014; 40:1603–1610.

14. Grönvall M1, Tikkanen M, Tallberg E, Paavonen J, Stefanovic V. Use of Bakri balloon tamponade in the treatment of postpartum hemorrhage: a series of 50 cases from a tertiary teaching hospital. Acta Obstet Gynecol Scand. 2013; 92:433–438.

15. Diemert A, Ortmeyer G, Hollwitz B, Lots M, Somville T, Glosemeyer P, et al. The combination of intrauterine balloon tamponade and the B- Lynch procedure for the treatment of severe postpartum hemorrhage. Am J Obstet Gynecol. 2012; 206:e1–e4.

16. Alouini S. Bakri balloon tamponade as first step to manage severe postpartum haemorrhage. Ir J Med Sci. 2014; 183:693.

17. Georgiou C. Balloon tamponade in the management of postpartum haemorrhage: a review. BJOG. 2009; 116:748–757.

18. Gynaecologists, L.R.C.o.O.a., RCOG Placenta Praevia, Placenta Praevia Accrete and Vasa Praevia. Diagnosis and Management (Green-top Guideline No.27).