1170 One-step deflation of bakri intrauterine balloon tamponade is not associated with increased blood loss

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Postpartum hemorrhage (PPH) is a leading cause of maternal mortality. Bakri intrauterine balloon tamponade (IBT) for refractory hemorrhage decreases morbidity, need for additional surgery, and blood loss; however, the most effective deflation method is unknown. We aimed to determine if 1-step compared to serial deflation of the IBT is associated with less blood loss after removal. Retrospective cohort study of patients with PPH who received IBT from January 2012 to August 2020 at a single institution. Patients were excluded if the IBT remained in place for fewer than 2 hours. The primary exposure was deflation method: 1-step (removed in 1 pass) or serial (in >1 pass). The primary outcome was estimated blood loss (EBL) from the initiation of IBT deflation to discharge. Secondary outcomes included clinically estimable blood loss (≥200 mL) after IBT deflation, need for additional interventions, postpartum fever and endometritis. 279 patients received an IBT which remained in place for ≥2 hours following PPH. The IBT was deflated in a single pass (1-step) in 112 (40%) and serially in 167 (60%). Baseline characteristics and pre-IBT hemorrhage were similar, except the serial group had less pre-existing hypertension, less labor augmentation with oxytocin, more multiple gestations, and higher EBL prior to IBT placement (Table 1). EBL after starting IBT deflation was greater in the 1-step group (42±294 mL 1-step vs 28±48 mL serial, p <0.001). There was no difference in rate of clinically significant EBL (2.7% 1-step vs 2.4% serial, p = 1.0), including after adjusting for pre-IBT EBL and other baseline characteristics. No difference was seen in need for additional interventions. Rates of postpartum fever (29% vs 32%, p=0.57) and endometritis (11% vs 17%, p=0.18) were not different based on 1-step vs serial deflation, respectively (Table 2). Patients with PPH whose IBT was deflated all at once did not have more post-IBT blood loss compared to those deflated serially, nor was there any difference in rate of need for additional interventions.View Large Image Figure ViewerDownload Hi-res image Download (PPT)