Efficacy of Bakri Balloon Tamponade in Massive Postpartum Hemorrhage: A Series of 57 Cases

Purpose : To evaluate the efficacy of intrauterine Bakri balloon tamponade as a management of massive postpartum hemorrhage (PPH). Methods : Retrospective study including women who underwent intrauterine Bakri balloon tamponade for massive PPH between April 2010 and July 2015 was conducted. Massive PPH was defined as estimated blood loss exceeding 1,500 mL. Bakri balloon was inserted into uterus if women had PPH despite medical treatment after vaginal delivery or cesarean section. The balloon was inflated with sterile saline and removed after 12-24 hours. Failure was defined as needing another procedure for hemorrhage control. Demographic, obstetric and specific factors in regard to the Bakri balloon use were recorded. The successful rate of hemostasis by Bakri balloon was evaluated. Results : Among 138 women with PPH managed Bakri balloon insertion, 57 patients were diagnosed with massive PPH. The most common cause of massive PPH was placenta previa without accreta (54.4%), uterine atony (33.3%), placenta previa with accreta (10.5%) and placenta accreta (1.8%). The mean estimated blood loss was 2279.0 mL (range, 1,500-6,500 mL). The rate of successful control of massive PPH after Bakri balloon placement was 82.5%. From the cases of 57 patients, 10 patients needed additional procedures; five required uterine artery embolization and five underwent cesarean hysterectomy. No short-term complications or maternal death were observed after Bakri balloon insertion. Conclusion : Bakri balloon tamponade is an effective, simple and quick approach in the treatment of massive PPH and it is useful as complementary management for earning time for another procedure.ope