Factors Associated with Failure of Bakri Balloon Tamponade for the Management of Postpartum Haemorrhage. Case Series Study and Systematic Review

Abstract

Background: Postpartum haemorrhage (PPH) is an unpredictable obstetric emergency that requires a multidisciplinary approach. Bakri balloon tamponade (BBT) is recommended when PPH does not respond to medical treatment. Nowadays few published studies have performed a multivariate analysis to determine the variables independently associated with BBT failure. Methods: Our study purpose was to determine the variables independently associated with BBT failure: first, in a large single-centre cohort study between 2010 and 2020, and second, in a systematic literature review using Medline and the Cochrane Library. Maternal and perinatal variables, PPH characteristics, technique-related variables and complications were recorded in the case series study, comparing between successful and failed BBT patients. Study characteristic and variables significantly associated with BBT failure were recorded in the systematic review. All studies used a logistic regression test. Results: The case series included 123 patients. The profile of these patients were primiparous, with vaginal delivery and a full-term new-born. BBT was successful in 81.3% of cases. Five studies were included in the systematic review, providing data from 551 patients. BBT was successful in 79.5% of cases. Conclusions: Maternal age, caesarean delivery, ≥7 red blood cells units (RBCU) transfused and curettage before BBT insertion, history of caesarean section, pre-pregnancy obesity, anteriorly placed placenta, placenta accreta, caesarean delivery, estimated blood loss before insertion of BBT, long operation duration, and coagulopathy were independent factors for BBT failure.

Uterine Artery Embolization of Uterine Arteriovenous Malformation: A Systematic Review of Success Rate, Complications, and Posterior Pregnancy Outcomes

“…The fact that the success rate after the first embolization is higher than after repeated embolizations (79.2% vs. 66.7%) indicates that the longer it takes to correct the bleeding, the less successful the embolization is. The time factor has been associated with the failure of other obstetric hemorrhage treatments, such as the Bakri balloon [ 13 ]. There have been no studies comparing the effectiveness of repeat embolization versus medical therapy or hysterectomy for persistent bleeding after initial embolization.…”

Risk Factors of Bakri Balloon Tamponade Failure for Persistent Postpartum Hemorrhage

“…In agreement with our results, Wang et al [7] also reported that DIC development is one of the risk factors in the BBT failure. Ruiz Labarta et al [11] found that EBL before insertion was associated with BBT failure. In addition, PAS is associated with life-threatening maternal PPH.…”

“…Therefore, BBT is effective in the treatment of PPH and has the value of clinical promotion. Factors for BBT failure mainly included pre-pregnancy obesity, maternal age, caesarean delivery, estimated blood loss before BBT insertion, long operation duration, and coagulopathy [11,12]. To reduce massive hemorrhage more effectively, it is necessary to identify the risk factors of BBT failure.…”

Uterine perforation by Bakri balloon following management of secondary postpartum haemorrhage: a case report and review of literature

“…In a recent work by Labarta et al risk factors associated with PPH that were found were induction of labour (47.2%), twin pregnancies in 22% and 12% had a previous caesarean section. 8 However, the main cause of PPH was uterine atony in 69%, with retained tissue in 11%. To arrest bleeding, 65% of women required a uterine curettage before insertion of the Bakri balloon.…”