title: Comparison between two management protocols for postpartum hemorrhage during cesarean section in placenta previa: Balloon protocol versus non-balloon protocol.
abstract: OBJECTIVE
  This study was conducted to compare two management protocols for post-partum hemorrhage (PPH) during cesarean section (CS) in placenta previa (PP), Bakri balloon protocol versus non-balloon protocol. Secondary analysis among balloon treated cases was also performed to identify predictors of success, failure or complications, if any.
  
  
  METHODS
  A prospective cohort study was conducted in two hospitals in Saudi Arabia, including cases that developed PPH during CS for PP. The primary outcome measure was success in preventing hysterectomy, while secondary outcome measures were amount of blood loss, need for blood transfusion, need for return to theater and admission to intensive care unit.
  
  
  RESULTS
  One hundred and fifty-one cases were identified as low-lying placenta and PP, of which 114 developed PPH. Two patients were unstable and required immediate hysterectomy. The remaining 112 cases were managed by balloon (72 cases) or non-balloon protocols (40). The balloon alone was successful in achieving hemostasis in 87.5% of cases. When analyzed specifically, balloon success was associated with the absence of accreta (odds ratio 0.001, confidence interval 0.000-0.974) and short operation duration (odds ratio 1.143, confidence interval 1.018-1.282).
  
  
  CONCLUSIONS
  Application of the Bakri balloon for the management of PPH after CS in cases of PP is an effective strategy that should be affordable worldwide.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Shebin-Elkom, Egypt.|Al-Hayat National Hospital, Khamis-Mushait, Saudi Arabia.
authors.forename: Mohammad Ahmed
authors.initials: MA
authors.lastname: Maher
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Ain-shams University, Cairo, Egypt.|Armed Forces Hospital North-West Region, Tabouk, Saudi Arabia.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abdelaziz
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D007044:Hysterectomy; D010923:Placenta Previa / Q000601:surgery*; D006473:Postpartum Hemorrhage / Q000601:surgery*; D011247:Pregnancy; D011446:Prospective Studies; D012529:Saudi Arabia; D016896:Treatment Outcome; D058738:Uterine Balloon Tamponade / Q000379:methods*; D055815:Young Adult
keywords: Bakri balloon; cesarean section; intrauterine balloon; placenta previa; post-partum hemorrhage