Abstract
Aim:
To evaluate the success rate and protocol of the Bakri balloon for postpartum hemorrhage (PPH) in the course of a prospective observational multicenter cohort study in South China.
Methods:
At 20 hospitals in South China, women with postpartum bleeding who failed to respond to the first-line conservative management and received the Bakri balloon were recruited for the study. Maternal characteristics, PPH characteristics, PPH management and outcomes in regard to the Bakri balloon use were recorded.
Results:
A total of 472 women had a Bakri balloon tamponade and 407 (86.23%) women were enrolled (67 after vaginal delivery and 340 either during or after cesarean delivery). The success rate of the Bakri balloon in this study was 91.65% (373/407 women). During vaginal deliveries, the group with a hemorrhage >2000 mL before balloon insertion had significantly more blood loss (551.67±635.17 mL vs. 242.06±313.69 mL, P=0.039) and lower maternal hemoglobin (73±21.77 g/L vs. 92.06±19.60 g/L, P=0.029) after using Bakri balloon than the group with a hemorrhage <1000 mL. Similar data were found during cesarean deliveries. The blood loss before and after balloon insertion were significantly higher in the Bakri balloon failure group (1700±1429.88 mL before and 1209.58±1139.72 mL after using the balloon) than those in the success group [918±493.92 mL before (P=0.002) and 266.57±361.60 mL after using the balloon (P=0.001)].
Conclusion:
Rapid diagnosis or prognosis of PPH, in combination with early usage of the Bakri postpartum balloon is more effective for the management of PPH.
Sources of the study: The study was coordinated by the First Affiliated Hospital of Sun Yat-sen University in China. Sources from Department of Obstetrics and Gynecology at 20 hospitals in Guangdong, China:
The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, The Six Affiliated Hospital of Sun Yat-sen University, Guangzhou, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangzhou Women and Children’s Medical Center, Guangzhou, Huadu District People’s Hospital of Guangzhou, Guangzhou, Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, Dongguan Maternity and Child Health Hospital, Dongguan, Zhuhai Maternity and Child Healthcare Hospital, Zhuhai, The First Maternity and Child Healthcare Hospital of Huizhou, Huizhou, Nanhai Maternity and Child Healthcare Hospital, Foshan, Jiangmen Maternity and Child Health Care Hospital, Jiangmen, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Zhujiang Hospital of Southern Medical University, Guangzhou, Zhongshan Dongsheng hospital, Zhongshan, Xiaolan People’s Hospital of Zhongshan, Zhongshan, The Eastern Hospital of The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Baoan District People’s Hospital of Shenzhen, Shenzhen, Zengcheng District People’s Hospital of Guangzhou, Guangzhou.
Author’s statement
Conflict of interest: Authors state no conflict of interest.
Material and methods: Informed consent: Informed consent has been obtained from all individuals included in this study.
Ethical approval: The research related to human subject use has complied with all the relevant national regulations, and institutional policies, and is in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors’ institutional review board or equivalent committee.
References
[1] Obstetrics Subgroup, Chinese Society of Obstetrics and Gynecology, Chinese Medical Association. Guideline of prevention and treatment about postpartum hemorrhage. Zhonghua Fu Chan Ke Za Zhi. 2014;49:641–6.Search in Google Scholar
[2] Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2:e323–33.10.1016/S2214-109X(14)70227-XSearch in Google Scholar
[3] Lalonde A, International Federation of Gynecology and Obstetrics. Prevention and treatment of postpartum hemorrhage in low-resource settings. Int J Gynaecol Obstet. 2012;117:108–18.10.1016/j.ijgo.2012.03.001Search in Google Scholar
[4] Main EK, Goffman D, Scavone BM, Low LK, Bingham D, Fontaine PL, et al. National partnership for maternal safety: consensus bundle on obstetric hemorrhage. Obstet Gynecol. 2015;126:155–62.10.1097/AOG.0000000000000869Search in Google Scholar
[5] World Health Organization. WHO recommendations for the prevention and treatment of postpartum haemorrhage. Geneva: World Health Organization; 2012.Search in Google Scholar
[6] Tunçalp O, Souza JP, Gülmezoglu M. New WHO recommendations on prevention and treatment of postpartum hemorrhage. Int J Gynaecol Obstet. 2013;123:254–6.10.1016/j.ijgo.2013.06.024Search in Google Scholar
[7] Bakri YN, Amri A, Abdul Jabbar F. Tamponade-balloon for obstetrical bleeding. Int J Gynaecol Obstet. 2001;74:139–42.10.1016/S0020-7292(01)00395-2Search in Google Scholar
[8] Cho Y, Rizvi C, Uppal T, Condous G. Ultrasonographic visualization of balloon placement for uterine tamponade in massive primary postpartum hemorrhage. Ultrasound Obstet Gynecol. 2008;32:711–3.10.1002/uog.5408Search in Google Scholar
[9] Grönvall M, Tikkanen M, Tallberg E, Paavonen J, Stefanovic V. Use of Bakri balloon tamponade in the treatment of postpartum hemorrhage: a series of 50 cases from a tertiary teaching hospital. Acta Obstet Gynecol Scand. 2013;92:433–8.10.1097/01.aoa.0000446322.20716.afSearch in Google Scholar
[10] Olsen R, Reisner DP, Benedetti TJ, Dunsmoor-Su RF. Bakri balloon effectiveness for postpartum hemorrhage: a “real world experience”. J Matern Fetal Neonatal Med. 2013;26:1720–3.10.3109/14767058.2013.796354Search in Google Scholar
[11] Georgiou C. Balloon tamponade in the management of postpartum haemorrhage: a review. Br J Obstet Gynaecol. 2009;116:748–57.10.1111/j.1471-0528.2009.02113.xSearch in Google Scholar
[12] Vintejoux E, Ulrich D, Mousty E, Masia F, Marès P, de Tayrac R, et al. Success factors for Bakri™ balloon usage secondary to uterine atony: a retrospective, multicentre study. Aust N Z J Obstet Gynaecol. 2015;55:572–7.10.1111/ajo.12376Search in Google Scholar
[13] Gao Y, Wang Z, Zhang J, Wang D, Yin B, Zhu B, et al. Efficacy and safety of intrauterine Bakri balloon tamponade in the treatment of postpartum hemorrhage: a multicenter analysis of 109 cases. Zhonghua Fu Chan Ke Za Zhi. 2014;49:670–5. Chinese.Search in Google Scholar
[14] Brown H, Okeyo S, Mabeya H, Wilkinson J, Schmitt J. The Bakri tamponade balloon as an adjunct treatment for refractory postpartum hemorrhage. Int J Gynaecol Obstet. 2016;135:276–80.10.1016/j.ijgo.2016.06.021Search in Google Scholar
[15] Laas E, Bui C, Popowski T, Mbaku OM, Rozenberg P. Trends in the rate of invasive procedures after the addition of the intrauterine tamponade test to a protocol for management of severe postpartum hemorrhage. Am J Obstet Gynecol. 2012;207:281.e1–7.10.1016/j.ajog.2012.08.028Search in Google Scholar
[16] Dildy GA 3rd. Postpartum hemorrhage: new management options. Clin Obstet Gynecol. 2002;45:330–44.10.1097/00003081-200206000-00005Search in Google Scholar
[17] Alkış İ, Karaman E, Han A, Ark HC, Büyükkaya B. The fertility sparing management of postpartum hemorrhage: A series of 47 cases of Bakri balloon tamponade. Taiwan J Obstet Gynecol. 2015;54:232–5.10.1016/j.tjog.2014.03.009Search in Google Scholar
[18] Doumouchtsis SK, Papageorghiou AT, Arulkumaran S. Systematic review of conservative management of postpartum hemorrhage: what to do when medical treatment fails. Obstet Gynecol Surv. 2007;62:540–7.10.1097/01.ogx.0000271137.81361.93Search in Google Scholar
[19] Condous GS, Arulkumaran S, Symonds I, Chapman R, Sinha A, Razvi K. The “tamponade test” in the management of massive postpartum hemorrhage. Obstet Gynecol. 2003;101:767–72.Search in Google Scholar
[20] Georgiou C. Intraluminal pressure readings during the establishment of a positive ‘tamponade test’ in the management of postpartum haemorrhage. Br J Obstet Gynaecol. 2010;117:295–303.10.1111/j.1471-0528.2009.02436.xSearch in Google Scholar
[21] Yorifuji T, Tanaka T, Makino S, Koshiishi T, Sugimura M, Takeda S. Balloon tamponade in atonic bleeding induces uterine contraction: attempt to quantify uterine stiffness using acoustic radiation force impulse elastography before and after balloon tamponade. Acta Obstet Gynecol Scand. 2011;90:1171–2.10.1111/j.1600-0412.2011.01169.xSearch in Google Scholar
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