The Bakri tamponade balloon as an adjunct treatment for refractory postpartum hemorrhage.
OBJECTIVE
To evaluate the Bakri tamponade balloon as an adjunct treatment for refractory postpartum hemorrhage (PPH).


METHODS
A prospective observational intervention study was conducted between January 1, 2013, and May 31, 2015, at Great Lakes Hospital and Moi Teaching and Referral Hospital in Kenya. Eligible participants were diagnosed with PPH (blood loss >500mL after vaginal or >1000mL after cesarean delivery, and/or hemodynamic changes suggestive of excessive blood loss) unresponsive to standard intervention and were treated using the Bakri balloon. Case report forms were completed for all participants. The primary endpoint was the frequency of surgery after use of the Bakri balloon.


RESULTS
Among 58 patients, postpartum bleeding was controlled without further surgical intervention in 55 (95%). Among the 55 women with uterine atony, the Bakri balloon successful controlled PPH in 52 (95%). Two of the three hysterectomies performed were for continued bleeding after placement of the Bakri tamponade balloon. Four maternal deaths occurred.


CONCLUSIONS
The Bakri tamponade balloon proved an effective adjunct in the management of refractory PPH.
Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA. Electronic address: haywood.brown@duke.edu.
Haywood
H
Brown
Department of Obstetrics and Gynecology, Great Lakes Hospital, Kisumu, Kenya.
Stephen
S
Okeyo
Department of Obstetrics and Gynecology, Moi Teaching and Referral Hospital, Eldoret, Kenya.
Hillary
H
Mabeya
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA.
Jeffrey
J
Wilkinson
Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA.
John
J
Schmitt
D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D007630:Kenya; D006473:Postpartum Hemorrhage / Q000401:mortality / Q000628:therapy*; D011247:Pregnancy; D011446:Prospective Studies; D012017:Referral and Consultation; D016896:Treatment Outcome; D058738:Uterine Balloon Tamponade / Q000379:methods*; D014593:Uterine Inertia / Q000453:epidemiology*; D055815:Young Adult
Bakri balloon; Mortality; Operative morbidity; Refractory postpartum hemorrhage