The use of the Bakri balloon in the management of postpartum haemorrhage: 7 year experience from one metropolitan health service.

Abstract

Introduction Postpartum haemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide. While the mainstay of management of primary PPH remains pharmacological a significant number of women will require surgical measures such as a compression suture or hysterectomy. In 2001 a less invasive approach was described, namely the insertion of an inflatable balloon (Bakri balloon) into the uterine cavity to tamponade uterine haemorrhage secondary to atony. In this study we aimed to assess the effectiveness of the Bakri balloon in reducing the need for surgical management in women with a major PPH in whom medical therapy had failed. Methods A retrospective analysis of all cases of severe PPH in which a Bakri balloon was used since its introduction to a single Victorian health service delivering about 8000 women per year. Results In our health service, between May 2008 and September 2014, 78 women had a Bakri balloon inserted for PPH, with a mean (range) age of 32 (23-44) years and a mean (range) gestation at delivery of 38+4 (30+4-42+0) weeks. Over the 7 years, the use of the Bakri balloon in our service is generally increasing, with three in 2008, nine in 2009, 12 in 2010, 14 in 2011, 11 in 2012, nine in 2013, and 20 in 2014. Thirty-six (46%) woman had had a vaginal birth, 23 (30%) an elective caesarean section and 19 (24%) an emergency caesarean section. The average (range) volume of estimated blood loss was 2590 (400-10 000) mL. The average (range) duration of insertion of the Bakri balloon was 17.25 (0.5-36) hours. Overall, in 86% of women the Bakri balloon was sufficient management of the PPH. In the remaining 14% a hysterectomy was required. In those women, the average (range) estimated blood loss was 5400 (3000-10 000) mL. Conclusion In our service, the Bakri balloon appears an effective therapy the management of PPH, avoiding the need for hysterectomy in nearly 9 out of 10 women in which it is used. Assessment of factors that might predict it lack of success might be expected to improve its use and improve the care of individual women.