Intrauterine Bakri Balloon Research Articles

Timely use of Bakri intrauterine balloon tamponade contributes to the effectiveness in controlling severe postpartum hemorrhage.

The aim of the present study was to explore the effectiveness of Bakri intrauterine balloon tamponade (IUBT) in treating severe postpartum hemorrhage (SPPH). A cohort of 198 women with SPPH using IUBT were retrospectively selected. The baseline and maternal outcome characteristics were examined. The results demonstrated that women with SPPH had a high proportion of placenta accrete (53.0%). Bakri IUBT demonstrated a global effectiveness of 84.5% in SPPH treatment, accounting for 82.9% in women with placenta accrete. Compared with women with Bakri failure, women who experienced Bakri success had reduced rates of less use of pre-/post-IUBT intervention, blood transfusion, lower genital tract trauma, estimated blood loss (EBL), and a longer indwelling duration (P<0.05). Logistic regression revealed that the pre-IUBT intervention (OR=3.910; 95% CI: 1.684-9.079; P=0.002) was positively associated with hemostasis success, while lower genital tract trauma was negatively associated with Bakri success (OR=0.091; 95% CI: 0.009-0.894; P=0.040). Moreover, women diagnosed with placenta accrete underwent a greater number of transabdominal placed Bakri IUBT and pre-IUBT interventions than those without placenta accrete (P<0.05). No significant differences were observed in Bakri success, total EBL, pre-/post-IUBT EBL, infused volume of IUBT, IUBT indwelling duration, even the rate of hemostasis, lower genital tract trauma, blood transfusion, post-IUBT intervention, and puerperal fever between women with and without placenta accrete (P>0.05). In conclusion, placenta accrete may be the leading cause of SPPH. Bakri IUBT is an effective and safe measure for SPPH. Pre-IUBT intervention may be predictive of Bakri's success. The timely use of IUBT during labor may mitigate the impact of risk factors identified on PPH.

Efficacy of Bakri Intrauterine Balloon in Managing Postpartum Hemorrhage: A Comparative Analysis of Vaginal and Cesarean Deliveries with Placenta Accreta Spectrum Disorders.

BACKGROUND The incidence of placenta accreta spectrum disorder (PAS) has been increasing in past decades, and women with PAS are a high-risk maternal population. This study aimed to explore the performance of Bakri intrauterine balloon tamponade (IUBT) in the treatment of postpartum hemorrhage (PPH), among those with and without PAS. MATERIAL AND METHODS The outcomes of 198 women who underwent treatment for PPH using IUBT were retrospectively analyzed. The demographics and maternal outcomes were analyzed for vaginal and cesarean births, with PAS and without PAS. RESULTS Compared to women with vaginal births (n=130), women who underwent cesarean births (n=68) showed a higher proportion of age ≥35 years (χ²=6.85, P=0.013), multiple births (χ²=13.60, P<0.001), preeclampsia (χ²=9.81, P=0.002), use of transabdominal IUBT (χ²=84.12, P<0.001) and pre-IUBT interventions (χ²=41.61, P<0.001), but had less infused volume of physiological saline (t=6.41, P<0.001). Women with PAS (n=105) showed a higher rate of pre-IUBT intervention (χ²=4.96, P=0.029) and transabdominal IUBT placement (χ²=9.37, P=0.002) than non-PAS women (n=93). The 36 women with PAS (n=36) showed a higher rate of preeclampsia (χ²=4.80, P=0.029), pre-IUBT intervention (χ²=5.90, P=0.015), and transabdominal IUBT placement (χ²=14.94, P<0.001) and a shorter duration from delivery to Bakri insertion (χ²=3.31, P=0.002), than non-PAS women (n=32). CONCLUSIONS PAS was a major cause of PPH at 198 vaginal and cesarean births. An accurate and timely pre-IUBT intervention and Bakri IUBT placement was critical for controlling PPH in cesarean births, especially in women with PAS.

Low-Cost, Durable Sheepskin Uterine Model for Obstetric Hemorrhage Emergency Simulation.

Postpartum hemorrhage is a common obstetrical emergency. Because the majority of cases respond to conservative medical therapies, trainees have limited clinical experience with hemostatic sutures or placement of a Bakri intrauterine balloon for refractory postpartum hemorrhage. Simulations provide an invaluable adjunct to resident education to learn and practice these hemostatic techniques. We aimed to create a low-cost, reproducible simulation model to prepare residents for uterine atony interventions such as B-Lynch, Bakri balloon placement, and uterine artery ligation. Using low-cost supplies, a reusable, life-sized recent postpartum uterus was constructed from pieces of sheepskin and sewn together with various expired suture. The sheepskin material allowed for repeated, secure placement of B-Lynch and O'Leary sutures and Bakri balloons, as well as offering the required compressibility to simulate a boggy uterus. Finally, sections of a red robin catheter were incorporated along the lateral lower borders of the model to simulate blood vessels for practicing uterine artery ligations. The model was used about 50 times over the span of 3 years to practice uterine hemostatic suturing. Residents found this model lifelike, accurate in size, and multifunctional for practicing these various techniques. The sheepskin material proved to be very resistant to repeated suturing, and also provided strong suture pull through strength. The durability of the sheepskin material demonstrates that this model can be used for repeated simulations or individual practice. The sheepskin uterus model provides trainees a realistic, low-cost, reproducible, simulation of a hypotonic uterus and allows for multiple modalities for managing postpartum hemorrhage. · We provide instructions for the creation of a sheepskin model for obstetric hemorrhage simulation.. · We demonstrate use of the sheepskin model in various obstetric hemorrhage management techniques.. · We demonstrate that the model is durable and lifelike based off of resident feedback..

Successfulness of the Bakri intrauterine balloon for uterotonic-unresponsive postpartum haemorrhage treatment: systematic review and meta-analysis.

Successfulness of the Bakri intrauterine balloon for uterotonic-unresponsive postpartum haemorrhage treatment: systematic review and meta-analysis.

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

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)

Efficacy of Prophylactic Antibiotics in Bakri Intrauterine Balloon Placement: A Single-Center Retrospective Analysis and Literature Review.

Objective Bakri intrauterine balloon (BIUB) placement is an effective treatment for postpartum hemorrhage (PPH). This study aims to evaluate the risk of infection during BIUB placement. Study Design Data for all deliveries ( n = 2,144) at our institution between January 2014 and March 2018 were retrospectively reviewed. Patients diagnosed with PPH ( n = 758) were included in our analysis, further divided into BIUB ( n = 80) and non-BIUB groups ( n = 678), and subdivided into vaginal delivery (VD), elective cesarean delivery (CD), and emergency CD groups. Postpartum endometritis rate was compared in each group. A single dose of prophylactic antibiotics was administered for BIUB placement in the VD group. In the CD groups, antibiotics were administered preoperatively once, and no additional antibiotics for BIUB placement were administered. To obtain an antibiotics administration protocol to be applied during BIUB placement, we electronically searched the PubMed and Scopus databases. Results No significant differences were observed in endometritis rates between BIUB and non-BIUB groups of all groups. In the literature review, of 27 suitable publications identified, multiple doses of antibiotics were administered in 17 (62.9%) studies and none investigated the efficacy of a protocol for antibiotic. Conclusion Our protocol might be effective and sufficient in preventing postpartum BIUB placement-related endometritis.

Effect of a Combined Hemostatic Technique during Cesarean Section in Placenta Previa

Objective: Only a few methods, besides cesarean hysterectomy, are available for controlling intractable bleeding in placenta previa. We aimed to evaluate the effect of the combined hemostatic technique during cesarean section for placenta previa. Methods: We retrospectively reviewed all cesarean deliveries for placental previa performed from April 2013 to December 2018 at Jeonbuk National University Hospital. Medical records were reviewed to determine the amount of red blood cell transfusion, degree of blood loss, and incidence of postpartum hysterectomy and uterine artery embolization between the conventional method and combined technique. Conventional hemostatic technique group undergo usual cesarean section surgery, and combined hemostatic technique comprises temporary bilateral ovarian artery clamping, bilateral uterine artery ligation, and intrauterine Bakri balloon (Cook Medical, Bloomington, IN, USA) tamponade. Results: There were 135 cesarean deliveries for placenta previa during the study period (conventional hemostatic method, n=100; combined hemostatic technique, n=35). The index of blood loss (conventional vs. combined, 0.22±}0.13 vs. 0.22±}0.11, P=0.90) was not different between the two groups. However, the mean amount of intraoperative red blood cell transfusion (0.88±}2.12 vs. 0.55±}0.93 units, P=0.02) was significantly lower in the combined technique group. The incidence of postpartum hysterectomies (5 vs. 0, P=0.025) and postpartum treatments (13 vs. 0, P=0.006) for continuous bleeding after cesarean section was also significantly lower in the combined technique group. Conclusion: Our findings suggest that combined hemostatic technique is associated with less intraoperative red blood cell transfusion and a decreased rate of postpartum hysterectomy and additional hemostatic procedures after cesarean section for placenta previa.

Severe postpartum hemorrhage with placental abruption managed by the uterine sandwich: a case report

Purpose of investigation: The authors report a case of severe postpartum hemorrhage (PPH) with placental abruption managed using the uterine sandwich. Case Report: A 24-year-old woman with placental abruption was referred to Yamaguchi Grand Medical Center at 35 weeks of gestation. Cesarean section was performed, and severe PPH occurred. After an intrauterine Bakri balloon and B-Lynch suture were applied and uterine bleeding was controlled. The total blood loss was 4, 090 ml. Transfusion included 16, 22, and 20 U of red cell concentrates (RCC), fresh frozen plasma (FFP), and platelet concentrates (PC), respectively. The patient was discharged with no complications eight days postoperatively. Conclusion: The uterine sandwich is an effective option for the treatment of severe PPH.

Removal of Bakri Intrauterine Balloon by Rapid or Stepwise Deflation: Which Technique is Better? [5A

INTRODUCTION: Intrauterine balloon tamponade (IBT) is an effective method for reducing the morbidity associated with postpartum hemorrhage but the best method for removal is unknown. The objective of this study is to determine whether stepwise deflation of the IBT is associated with a reduced likelihood of secondary hemorrhage and blood loss after removal. METHODS: This is a retrospective cohort study of patients who received an IBT from 2012-2016. Patients were included if the IBT remained in place at least 2 hours and were excluded in cases of failed IBT placement. Patients were assigned to 1 of 2 groups: the (1) RAPID group underwent deflation all at once and the (2) STEPWISE group underwent deflation in 2 or more serial visits. RESULTS: 124 subjects met our inclusion criteria: 24 underwent Rapid deflation and 100 underwent Stepwise deflation. There were no significant differences in baseline characteristics between the two groups. Less blood loss after deflation was noted in the patients who underwent Rapid deflation compared to the Stepwise Group (2.1 vs 31 mL, p = 0.005). There were no instances of significant post-deflation hemorrhage in either group. There were no differences in other secondary outcomes including need for additional interventions. CONCLUSION: Rapid deflation was associated with less blood loss, though this may reflect a reduced likelihood of accurate measurement in this group given that the catheter is no longer in situ. Rapid deflation rather than stepwise deflation should be considered (and may be preferred) for IBT removal.

Intraluminal pressure of uterine balloon tamponade in the management of severe post-partum hemorrhage.

Intrauterine balloon tamponade has been increasingly used for the management of post-partum hemorrhage (PPH) in recent years. However, data on the precise mechanisms and pressure required for the balloon tamponade are scanty in the literature. This study aims to review the intraluminal pressure (ILP) generated by the Bakri intrauterine balloon that is necessary to produce a 'positive tamponade test' during severe PPH. This was a prospective cohort study. The ILP of the Bakri balloon was measured using a manometer after a positive tamponade test was clinically achieved during severe PPH (blood loss >1 L). The patient's blood pressure was recorded, and ultrasound scan was performed to verify the position of the balloon and the presence of forward flow in the uterine arteries. The main outcome measure is the ILP of the Bakri balloon required to achieve a positive tamponade test. Twenty patients were included for final analysis. The net ILP measured ranged from 67 to 92 mmHg, and this pressure was lower than the concurrent systolic pressure in all cases. Color Doppler confirmed positive forward flow in the uterine vessels in all cases. There were no differences in the pressure measured with the balloon position, and there was no relationship between the volumes of saline infused and the net pressure. A positive tamponade test in an intrauterine balloon is probably achieved by local compression pressure exerted on the vasculature of the placental bed rather than by generating an ILP exceeding systemic blood pressure or by occlusion of flow to the uterine arteries.

Intrauterine Bakri Balloon and Vaginal Tamponade Combined with Abdominal Compression for the Management of Postpartum Hemorrhage

ObjectiveThis study sought to investigate the effect of Bakri balloon use and vaginal tamponade combined with abdominal compression for the management of postpartum hemorrhage (PPH). MethodsThis retrospective study reviewed cases of PPH in the International Peace Maternal and Child Health Hospital of China Welfare Institution in Shanghai, China from January 1, 2010 to December 31, 2015. A single use of the intrauterine Bakri balloon was applied in some cases, and additional vaginal tamponade combined with abdominal compression (double compression) was applied in other cases. The authors evaluated the effect of these two methods in the management of PPH. ResultsThe Bakri balloon was used in 305 cases of intrauterine PPH, and the clinical efficacy was 93.26%. One group of study patients underwent double compression, and these patients had a better clinical efficacy rate of 96.3% (157 of 163), whereas the efficacy in cases using the Bakri balloon alone (control group) was 87.3% (124 of 142). The postoperative complication rates of these two groups were 9.4% and 8.7%, respectively. Uterine arterial embolization was performed in patients in whom Bakri balloon use failed. None of the cases resulted in a hysterectomy. ConclusionIntrauterine Bakri balloon use combined with vaginal tamponade and abdominal compression is more effective in the treatment of PPH compared with Bakri balloon use alone. This method does not increase postoperative complications. Uterine atony with placenta previa or implantation may be possible reasons for noneffectiveness of Bakri balloon use.

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.

Efficacy of Intrauterine Bakri Balloon Tamponade in Cesarean Section for Placenta Previa Patients.

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.

Efficacy and safety of intrauterine Bakri balloon tamponade in the treatment of postpartum hemorrhage: a multicenter analysis of 109 cases

To evaluate the efficacy and safety of the Bakri balloon in the treatment of postpartum hemorrhage (PPH). A total of 109 patients with PPH who underwent Bakri balloon insertion after unsuccessful first- line medication from thirteen hospitals in Guangdong from Apr. 2013 to Oct. 2013 were recruited in this study. Bakri balloons were applied via vagina or abdomen depending on the delivery mode. The high risk factors and the causes of the PPH were analyzed. The bleeding volume of before and after placing Bakri balloon, the hemoglobin drop-out value, the interval time between the delivery and applying Bakri, the placement mode, staying time, and the complications were recorded. To stratified analyze the Bakri balloon hemostasis success rate and evaluate its safety. (1) The average amount of 24 hours PPH of all 109 cases was 1 523 ml. Successful hemostasis was achieved in 102 cases after Bakri balloon placement, defined as success group. In the other 7 cases, bleeding were not controlled, defined as failure group (six patients underwent hysterectomy). The overall Bakri balloon hemostasis successful rate was 93.6% (102/109), and the failure rate was 6.4% (7/109). The successful rate in cesarean section group was 94% (93/99), and in vaginal delivery group was 9/10. In the patients with placenta previa, placenta increta or scar uterus, the successful rate of Bakri balloon hemostasis was 88% (45/51), 13/16 and 95% (19/20), respectively, and were slightly below the overall successful rate. (2) Data showed that PPH volume after Bakri balloon placement was significantly lower in the success group (364 ml) than that in the failure group (1 533 ml, P < 0.05). However, the hemoglobin drop-off value and the case number that need blood transfusion had no statistically significant difference (P > 0.05). (3) The Bakri balloons were placed via vagina in 38 cases, and successful hemostasis was achieved in 36 cases, with the successful rate of 95% (36/38). The balloons were placed via cesarean section incision in 71 cases, and succeeded in 66 cases, the successful rate was 93% (66/71). There was no statistically significant difference between the two approaches. The retaining time of Bakri balloon was (22.0 ± 3.0) hours in success group and (3.0 ± 1.0) hours in failure group, with statistically significant difference (P < 0.05). (4) There was no intrauterine infection occurred. Ultrasound scan after 6 weeks postpartum found no abnormal signs in pelvis. All patients were followed up for 2-6 months postpartum, no complications were found. Bakri balloon tamponade is an effective, safe, simple and quick approach in the treatment of PPH.

Balloon tamponade for postpartum haemorrhage: case series and literature review

To audit the use of intrauterine balloon tamponade for the management of massive postpartum haemorrhage and compare outcomes with those documented in the literature. Retrospective case series. Obstetric Unit of a regional hospital in Hong Kong. All cases with severe postpartum haemorrhage from January 2011 to June 2012 in which Bakri intrauterine balloon catheters were used for management. Successful management with prevention of hysterectomy. A total of 19 cases were identified. The postpartum haemorrhage was successfully treated without the need for additional procedures in 15 patients. Hysterectomy was avoided in a further two cases by recourse to radiologically guided uterine artery embolisation. In two patients, balloon tamponade failed in that hysterectomy was carried out. Thus, the overall success rate of intrauterine balloon tamponade alone was 79%, which was comparable to reported rates in the literature. Bakri balloon tamponade is an effective means of managing massive postpartum haemorrhage, and should be adopted in protocols to manage such patients.

The difficult PPH: Experience of combined use of B-Lynch brace suture and intrauterine Bakri balloon in York hospital, UK

The rate of life-threatening haemorrhage (blood loss ≥ 2.5 litres; or women who received more than 5 units of blood transfusion; or women who received treatment for coagulopathy after such an acute...

The difficult pph- experience of combined use of B-lynch brace suture and intrauterine Bakri Balloon York hospital

The rate of life-threatening haemorrhage (blood loss 2.5 litres or more or women who received more than 5 units of blood transfusion or women who received treatment for coagulopathy after...

OP33.05: The sonographic measurement of postpartum lower uterine segment thickness after intrauterine Bakri balloon tamponade

OP33.05: The sonographic measurement of postpartum lower uterine segment thickness after intrauterine Bakri balloon tamponade

Uterine Artery Pseudoaneurysm in the Setting of Delayed Postpartum Hemorrhage: Successful Treatment with Emergency Arterial Embolization

Postpartum hemorrhage is a major cause of maternal mortality. Though uncommon, uterine artery pseudoaneurysm can follow uterine dilatation and curettage (D + C) and needs to be considered in the differential diagnosis. This 30-year-old G1P1 woman presented with right upper quadrant pain and vaginal bleeding. She was afebrile but her white blood count was significantly increased (22.2 × 109 /L). One week prior, she had undergone a Cesarean delivery which was complicated by hemolysis, elevated liver enzymes, and low platelet count syndrome (HELLP), fetal dystocia, and chorioamnionitis. Uterine dilatation and curettage (D & C) and placement of a Bakri intrauterine balloon, performed for suspected retained products of conception, failed to control her postpartum bleeding. The patient wished to have a hysterectomy only as a last resort in order to preserve fertility. Emergency uterine artery angiography revealed a left uterine artery pseudoaneurysm and contrast extravasation. The patient was successfully treated with selective embolization. Computed tomography (CT) later revealed dehiscence of her uterine Cesarean section incision with an intra-abdominal fluid collection. This collection was drained. She also developed disseminated intravascular coagulopathy (DIC) syndrome as well as multiple pulmonary emboli which were both successfully treated. We discuss this unique case of uterine artery pseudoaneurysm with associated uterine dehiscence.

B-Lynch suture, intrauterine balloon, and endouterine hemostatic suture for the management of postpartum hemorrhage due to placenta previa accreta

Objective To report our experience with a new conservative management approach to treat postpartum hemorrhage (PPH) due to placenta previa accreta. Methods A retrospective study of 9 patients with placenta previa accreta who underwent a conservative management protocol. The protocol consists of preventive radiological catheterization of the descending aorta, cesarean delivery, use of Affronti endouterine square hemostatic sutures, and placement of an intrauterine Bakri balloon in conjunction with B-Lynch suture. In the event of failure of the protocol, subsequent management employs ligation and/or reversible embolization of the uterine arteries followed by hysterectomy if unsuccessful. Results Conservative management of PPH was successful in all 9 patients evaluated and avoided the need for ligation and/or reversible embolization of the uterine arteries. Conclusion Management of PPH is dictated by several considerations including hemodynamic status and desire to preserve fertility. The initial results of this conservative protocol for treatment of PPH in high-risk patients with placenta previa accreta are encouraging.