Use of Bakri balloon tamponade (BBT) for conservative management of postpartum haemorrhage: a tertiary referral centre case series

Abstract

The aim of this study was to investigate the efficacy of the Bakri balloon in the management of PPH. This was a retrospective review of 49 patients, who had Bakri balloon inserted for PPH in KK Hospital between April 2013 and December 2015. The main outcome measure was achievement of haemostasis by Bakri balloon tamponade (BBT). Our success rate was 81.6%. Out of the nine failures (18.0%), five (55.6%) had subtotal hysterectomies and four (44.4%) had total hysterectomies. The causes of PPH in these nine women were unsuspected or foci of placenta accreta (55.6%), uterine atony (33.3%) and retained products of conception (11.1%). Our study suggests that BBT is more likely to fail when bleeding is secondary to undiagnosed focal placenta accreta (p = .011) and when the estimated blood loss is more than 1.5 litres (p < .001). Our study adds to the growing body of evidence that BBT is not only effective for management of PPH in haemodynamically stable patients and in cases secondary to uterine atony and placenta praevia, but also in a small number of undiagnosed focal placenta accreta. Impact statement There is limited evidence regarding efficacy of BBT for PPH. Our study supports the use of BBT for PPH due to uterine atony and placenta praevia and in a small number of undiagnosed placenta accreta.

Predictors of Failed Intrauterine Balloon Tamponade in the Management of Severe Postpartum Hemorrhage

“…The success rate of IUBT alone in the management of severe PPH was 70.8%, which was slightly lower than in previous studies (8,11,17). This may be related to the higher proportion of PAS and cesarean sections.…”

Evidence-based guidelines for the management of abnormally invasive placenta: recommendations from the International Society for Abnormally Invasive Placenta

“…Also, it was not clear if the tamponade was used to prevent or treat hemorrhage. Three retrospective studies looking at treatment for PPH have also reported that the presence of an AIP is associated with a higher failure rate of balloon tamponade (level 4 evidence) [74][75][76] .…”

Local uterine resection with Bakri balloon placement in placenta accreta spectrum disorders

“…During the bladder dissection or at any operation stage, any bleeding that cannot be controlled is encountered, and definitive surgical procedure should not be delayed. It has been reported that balloon tamponade reduces blood loss and transfusion amounts, although it has a higher failure rate in the presence of PAS ( 31 , 32 , 33 ) (AJOG). We believe that the routine use of Bakri in these cases is beneficial in terms of reducing and following up bleeding in the postpartum period.…”