An alternative method of Bakri balloon placement for postpartum hemorrhage after vaginal delivery
Abstract
Objectives: We developed a new Bakri balloon tamponade (BBT) placement technique after vaginal delivery, which aimed to be faster without balloon slippage. This study compared the new method with standard placement of BBT in women with postpartum hemorrhage (PPH) after vaginal delivery.
Material and methods: This study was undertaken of women who underwent vaginal delivery at the obstetrics and gynecology departments of the Hospital of Chengdu University of Traditional Chinese Medicine, Sichuan Provincial Hospital for Women and Children, and Si Chuan JINXIN Women and Children Hospital between January 2014 and December 2020. Women who underwent BBT for PPH were grouped according to placement method into the old-BBT group and the new-BBT group.
Results: Of 20487 childbirths by vaginal delivery, 512 (2.50%) had PPH, 77 women underwent BBT (old-BBT n = 28, new-BBT n = 49). Background characteristics were similar except prothrombin time (PT, p < 0.01) and activated partial thromboplastin time (APTT, p < 0.004) were lower in the new-BBT group than the old-BBT group. The operation time was shorter in the new-BBT group (p < 0.001) with less bleeding (p < 0.003) and saline injection (p < 0.001). A balloon slippage was less likely (p < 0.008) and postoperative bleeding (p < 0.01), transfusion rate (p < 0.03), transfusion volume (p < 0.002), and hospital stay was lower in the new-BBT group (p < 0.015). Multivariate analysis suggested PT (OR = 0.039, 95% CI: 0.002–0.730, p < 0.030), international normalized ratio (OR = 8.244, 95% CI: 3.807–17.850, p < 0.009), and BBT method (OR = 5.200, 95% CI: 1.745-15.493, p < 0.003), were associated with requiring a blood transfusion.
Conclusions: This method of BBT placement reduced operation time, balloon slippage, bleeding, and hospital stay in women with PPH after vaginal delivery.
Keywords: postpartum hemorrhagebakri balloon tamponadevaginal deliveryretrospective studyballoon slippage
References
- Samimi M, Imani-Harsini A, Abedzadeh-Kalahroudi M. Carbetocin vs. Syntometrine in Prevention of Postpartum Hemorrhage: a Double Blind Randomized Control Trial. Iran Red Crescent Med J. 2013; 15(9): 817–822.
- Nagai S, Kobayashi H, Nagata T, et al. Clinical Usefulness of Bakri Balloon Tamponade in the Treatment of Massive Postpartum Uterine Hemorrhage. Kurume Med J. 2016; 62(1-2): 17–21.
- Evensen A, Anderson JM, Fontaine P. Postpartum Hemorrhage: Prevention and Treatment. Am Fam Physician. 2017; 95(7): 442–449.
- Ortega-Castillo VM, Espino y Sosa S, Herrerías-Canedo T. [Obstetric hemorrhage control Bakri balloon]. Ginecol Obstet Mex. 2013; 81(8): 435–439.
- Olsen R, Reisner DP, Benedetti TJ, et al. Bakri balloon effectiveness for postpartum hemorrhage: a "real world experience". J Matern Fetal Neonatal Med. 2013; 26(17): 1720–1723.
- Kaya B, Tuten A, Daglar K, et al. B-Lynch uterine compression sutures in the conservative surgical management of uterine atony. Arch Gynecol Obstet. 2015; 291(5): 1005–1014.
- Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, et al. Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014; 384(9947): 980–1004.
- Montufar-Rueda C, Rodriguez L, Jarquin JD, et al. Severe postpartum hemorrhage from uterine atony: a multicentric study. J Pregnancy. 2013; 2013: 525914.
- Alexander J, Thomas P, Sanghera J. Treatments for secondary postpartum haemorrhage. Cochrane Database Syst Rev. 2002(1): CD002867.
- Dahlke JD, Mendez-Figueroa H, Maggio L, et al. Prevention and management of postpartum hemorrhage: a comparison of 4 national guidelines. Am J Obstet Gynecol. 2015; 213(1): 76.e1–76.e10.
- Prevention and Management of Postpartum Haemorrhage: Green-top Guideline No. 52. BJOG. 2017; 124(5): e106–e149.
- Chandraharan E, Arulkumaran S. Surgical aspects of postpartum haemorrhage. Best Pract Res Clin Obstet Gynaecol. 2008; 22(6): 1089–1102.
- Doumouchtsis SK, Papageorghiou AT. Managing massive postpartum haemorrhage. BJOG. 2009; 116(12): 1687–1688.
- Viteri OA, Sibai BM. Uterine balloon tamponade for the management of postpartum haemorrhage: a challenge and an opportunity for better evidence. BJOG. 2018; 125(5): 540.
- Marasinghe JP, Du Plessis J, Epitawela D, et al. Management of postpartum haemorrhage with uterine balloon tamponade: The way forward. Aust N Z J Obstet Gynaecol. 2015; 55(4): 315–317.
- Bakri YN, Amri A, Abdul Jabbar F. Tamponade-balloon for obstetrical bleeding. Int J Gynaecol Obstet. 2001; 74(2): 139–142.
- Vrachnis N, Salakos N, Iavazzo C, et al. Bakri balloon tamponade for the management of postpartum hemorrhage. Int J Gynaecol Obstet. 2013; 122(3): 265–266.
- Charoenkwan K. Effective use of the Bakri postpartum balloon for posthysterectomy pelvic floor hemorrhage. Am J Obstet Gynecol. 2014; 210(6): 586.e1–586.e3.
- Alouini S. Bakri balloon tamponade as first step to manage severe post partum haemorrhage. Ir J Med Sci. 2014; 183(4): 693.
- Kawamura A, Kondoh E, Hamanishi J, et al. Cervical clamp with ring forceps to prevent prolapse of an intrauterine balloon in the management of postpartum hemorrhage. J Obstet Gynaecol Res. 2013; 39(3): 733–737.
- Ogoyama M, Takahashi H, Usui R, et al. Hemostatic effect of intrauterine balloon for postpartum hemorrhage with special reference to concomitant use of "holding the cervix" procedure (Matsubara). Eur J Obstet Gynecol Reprod Biol. 2017; 210: 281–285.
- Matsubara S, Kuwata T, Usui R, et al. 'Holding the cervix' technique for post-partum hemorrhage for achieving hemostasis as well as preventing prolapse of an intrauterine balloon. J Obstet Gynaecol Res. 2013; 39(5): 1116–1117.
- Matsubara S. Combination of an intrauterine balloon and the "holding the cervix" technique for hemostasis of postpartum hemorrhage and for prophylaxis of acute recurrent uterine inversion. Acta Obstet Gynecol Scand. 2014; 93(3): 314–315.
- Baskett TF. A flux of the reds: evolution of active management of the third stage of labour. J R Soc Med. 2000; 93(9): 489–493.
- Cho Y, Rizvi C, Uppal T, et al. Ultrasonographic visualization of balloon placement for uterine tamponade in massive primary postpartum hemorrhage. Ultrasound Obstet Gynecol. 2008; 32(5): 711–713.
- Allam MS, B-Lynch C. The B-Lynch and other uterine compression suture techniques. Int J Gynaecol Obstet. 2005; 89(3): 236–241.
- Haumonté JB, Sentilhes L, Macé P, et al. Prise en charge chirurgicale d’une hémorragie du post-partum. Journal de Gynécologie Obstétrique et Biologie de la Reproduction. 2014; 43(10): 1083–1103.
- Frenzel D, Condous GS, Papageorghiou AT, et al. The use of the "tamponade test" to stop massive obstetric haemorrhage in placenta accreta. BJOG. 2005; 112(5): 676–677.
- Esen UI. Re: The prevention and treatment of postpartum haemorrhage: what do we know, and where do we go next? BJOG. 2015; 122(8): 1145–1146.
- Georgiou C. Balloon tamponade in the management of postpartum haemorrhage: a review. BJOG. 2009; 116(6): 748–757.
