Bakri balloon tamponade is an effective and safe treatment for life-threatening postpartum hemorrhage (PPH)

Abstract

Introduction: Life-threatening post-partum hemorrhage (PPH) is still one of the major causes of perinatal maternal mortality. Uterine tamponade using the Bakri balloon system has been proposed as a new therapeutic to stop or alleviate PPH. This system may prevent the need for emergency hysterectomy and allow fertility preserving surgical options, such as uterine compression sutures. We report about a single center experience comprising 7 cases of severe PPH treated with this balloon tamponade. Methods: From 2005 11 cases of severe PPH needed surgical treatment (hysterectomy, uterine compression sutures (B-lynch)) or balloon tamponade. 4 cases received surgical treatment alone, 3 cases received balloon tamponade alone and 4 cases received a combination of both. We compared outcome, total blood loss, need for hysterectomy, major maternal morbidity according to treatment chosen. Results: In 8 cases PPH occurred after c-section, in 2 cases after vaginal delivery and in 1 case after abortion. Hysterectomy was performed in 3 cases, twice because of secondary hemorrhage. Remarkably, all patients that needed hysterectomy were previously not treated with a balloon. In contrast, termination of PPH by balloon tamponade alone was achieved in 3 cases, whereas in the remaining 4 cases a combination of balloon-tamponade with B-lynch sutures was applied. Conclusion: We conclude that the balloon tamponade using the Bakri B balloon presents a valuable treatment option in cases of severe PPH. Especially a combination of B-lynch uterine compression sutures and balloon tamponade should be considered in cases of severe PPH. Balloon tamponade with this system is technichally easy and and may preserve fertility.