Use of Bakri balloon tamponade in the treatment of postpartum hemorrhage: a series of 50 cases from a tertiary teaching hospital.
OBJECTIVE
Massive postpartum hemorrhage (PPH) is one of the most serious complications during delivery. Hysterectomy is commonly performed when other conventional treatment attempts fail. Bakri balloon tamponade (BBT) is a novel conservative management option for PPH. Little is known of the effectiveness of this procedure. We report a large case series from a tertiary teaching hospital.


METHODS
Retrospective case series (October 2008-June 2011).


METHODS
University teaching hospital.


METHODS
Forty-four women with massive PPH (blood loss >1000 mL) and six other women with expected high risk of PPH (blood loss <1000 mL) managed by BBT.


METHODS
Chart review.


METHODS
Achievement of definitive hemostasis by BBT among the study population.


RESULTS
Among the women treated with BBT, the cause of PPH was uterine atony (16%), cervical rupture (14%), vaginal rupture and/or paravaginal hematoma (22%), placenta previa (18%) and placental retention (30%). The overall success rate was 86%. Seven of the 50 patients needed additional procedures. Of the seven failures, supravaginal uterine amputation or hysterectomy was required in four cases and embolization of the uterine arteries in three cases.


CONCLUSIONS
BBT is a simple, readily available, effective and safe procedure for the management of PPH in selective cases. BBT does not exclude the use of other procedures if necessary. Even if BBT failed, it may provide temporary tamponade and time to prepare for other interventions or transportation from local hospital to tertiary centre. We suggest that BBT should be included in the PPH protocol.
Department of Obstetrics and Gynecology, University Central Hospital, Helsinki, Finland.
Maiju
M
Grönvall
Minna
M
Tikkanen
Erika
E
Tallberg
Jorma
J
Paavonen
Vedran
V
Stefanovic
D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D005260:Female; D005387:Finland; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D013536:Suture Techniques; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D016896:Treatment Outcome; D058738:Uterine Balloon Tamponade / Q000379:methods*; D014599:Uterus / Q000098:blood supply; D016387:Women's Health; D055815:Young Adult