title: The impact of Bakri balloon tamponade on the rate of postpartum hysterectomy for uterine atony.
abstract: OBJECTIVE
  Our objective was to evaluate the impact of uterine tamponade with a Bakri balloon on the rate of postpartum hysterectomy due to uterine atony.
  
  
  METHODS
  We performed a retrospective cohort study of all deliveries >20 weeks gestation from January 2002 to March 2013 at Baystate Medical Center. Charts were reviewed to determine incidence of postpartum hysterectomy, Bakri balloon placement, uterine artery embolization (UAE) and the B-Lynch procedure. Patients with evidence of placenta accreta were excluded. The primary outcome was the change in rates of postpartum hysterectomy for uterine atony before and after the introduction of Bakri balloon tamponade, using chi-square testing.
  
  
  RESULTS
  There were 48 767 deliveries during the study period, with 17 950 before and 30 817 after the introduction of the Bakri balloon. A total of 43 Bakri balloons were placed during the study period and 21 hysterectomies were performed for postpartum hemorrhage secondary to uterine atony, 14 before and 7 after the introduction of the Bakri balloon. This was consistent with a decrease in the rate of postpartum hysterectomy from 7.8/10 000 deliveries to 2.3/10 000 deliveries (p = 0.01).
  
  
  CONCLUSIONS
  Our findings show that utilization of the Bakri balloon is associated with a decreased rate of postpartum hysterectomy.
authors.affiliation: a Department of Obstetrics and Gynecology , Baystate Medical Center , Springfield , MA , USA.
authors.forename: Anderson
authors.initials: A
authors.lastname: Lo
authors.affiliation: b Division of Academic Affairs , Epidemiology/Biostatistics Research Core, Baystate Medical Center , Springfield , MA , USA.
authors.forename: Peter
authors.initials: P
authors.lastname: St Marie
authors.affiliation: c The Marshfield Clinic , Minocqua , WI , USA.
authors.forename: Parul
authors.initials: P
authors.lastname: Yadav
authors.affiliation: d Case Western Reserve University School of Medicine , Cleveland , OH , USA , and.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Belisle
authors.affiliation: e Department of Maternal-Fetal Medicine , Baystate Medical Center , Springfield , MA , USA.
authors.forename: Glenn
authors.initials: G
authors.lastname: Markenson
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D006473:Postpartum Hemorrhage / Q000209:etiology / Q000628:therapy*; D049590:Postpartum Period; D011247:Pregnancy; D012189:Retrospective Studies; D058738:Uterine Balloon Tamponade / Q000295:instrumentation*; D014593:Uterine Inertia / Q000628:therapy*
keywords: B-Lynch; placenta previa; postpartum hemorrhage; uterine artery embolization; uterine artery ligation