Abstract
PurposeThe aims of this study were to analyze the predictive factors for the use of intrauterine balloon insertion and to evaluate the efficacy and factors affecting failure of uterine tamponade with a Bakri balloon during cesarean section for abnormal placentation.MethodsWe reviewed the medical records of 137 patients who underwent elective cesarean section for placenta previa between July 2009 and March 2014. Cesarean section and Bakri balloon insertion were performed by a single qualified surgeon. The Bakri balloon was applied when blood loss during cesarean delivery exceeded 1,000 mL.ResultsSixty-four patients (46.7%) required uterine balloon tamponade during cesarean section due to postpartum bleeding from the lower uterine segment, of whom 50 (78.1%) had placenta previa totalis. The overall success rate was 75% (48/64) for placenta previa patients. Previous cesarean section history, anterior placenta, peripartum platelet count, and disseminated intravascular coagulopathy all significantly differed according to balloon success or failure (all p<0.05). The drainage amount over 1 hour was 500 mL (20–1200 mL) in the balloon failure group and 60 mL (5–500 mL) in the balloon success group (p<0.01).ConclusionIntrauterine tamponade with a Bakri balloon is an adequate adjunct management for postpartum hemorrhage following cesarean section for placenta previa to preserve the uterus. This method is simple to apply, non-invasive, and inexpensive. However, possible factors related to failure of Bakri balloon tamponade for placenta previa patients such as prior cesarean section history, anterior placentation, thrombocytopenia, presence of DIC at the time of catheter insertion, and catheter drainage volume more than 500 mL within 1 hour of catheter placement should be recognized, and the next-line management should be prepared in advance.
Highlights
Placenta previa occurs in approximately 4.8 of every 1,000 pregnancies [1] and is associated with maternal mortality and significant increase in maternal morbidities including massive hemorrhage, infection, adjacent organ damage, and emergency hysterectomy [2, 3]
We reviewed the medical records of 137 patients who underwent elective cesarean section for placenta previa between July 2009 and March 2014
Sixty-four patients (46.7%) required uterine balloon tamponade during cesarean section due to postpartum bleeding from the lower uterine segment, of whom 50 (78.1%) had placenta previa totalis
Summary
Placenta previa occurs in approximately 4.8 of every 1,000 pregnancies [1] and is associated with maternal mortality and significant increase in maternal morbidities including massive hemorrhage, infection, adjacent organ damage, and emergency hysterectomy [2, 3]. Placenta previa-related uterine atony, bleeding from the lower flap of the uterine wall, and invasive placentation can cause postpartum hemorrhage (PPH) [4]. Intraoperative management options deployed to control hemorrhage in placenta previa patients include bimanual uterine compression, implantation site compression with sutures, uterine arterial ligation, pelvic arterial embolization, and hysterectomy. Arterial ligation and compression suture have a low success rate among inexperienced surgeons, pelvic arterial embolization requires high medical costs and sophisticated facilities, and hysterectomy has high morbidity and mortality and confers fertility loss. The overall success rate of balloon tamponade in controlling bleeding is reportedly 80% [6], but the heterogeneous causes of PPH, including uterine atony, retained placenta, genital tract laceration, and uterine rupture, are not specific for placenta previa [7]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
