Does keeping the Bakri balloon in place for longer than 12 hours provide favourable clinical outcomes in the treatment of uterine atony?
Abstract
Aim: If the initial treatment techniques fail, intrauterine balloon tamponade (IUBT) devices such as Bakri balloon tamponade (BBT) is an effective treatment for reducing the bleeding in uterine atony patients. However, the duration of the Bakri balloon varies widely in clinical practice, and there is no consensus in this issue. This study aimed to compare the clinical outcomes of the Bakri balloon removed in less or more than 12 hours in patients with severe postpartum haemorrhage (PPH).
Materials and methods: This retrospective study included 108 patients who underwent Bakri balloon for severe PPH after vaginal delivery. Patients were divided into two groups as the duration of Bakri balloon 8-12 hours (Group I) and >12 hours (Group II). BBT was considered to be successful if the bleeding was stopped, and the patient did not require additional invasive procedures. Age, parity, gestational week, cause of bleeding, presence of co-morbidity that may increase bleeding (multiple gestation, magnesium sulphate infusion), estimated blood loss (EBL) before and after Bakri balloon, postpartum infection, erythrocyte and fresh frozen plasma requirement and invasive procedure requirement of the groups were compared.
Results: In group I, 26 patients (52%) underwent erythrocyte transfusion, and 18 patients (36%) underwent both erythrocyte and fresh frozen plasma (FFP) transfusion. In group II, 28 patients (41.2%) underwent erythrocyte transfusion, and 21 patients (30.9%) underwent both erythrocyte and FFP transfusion. These differences were not statistically significant (p=0.42 and p=0.21, respectively). Bacri balloon was failed to reduce bleeding in one patient (2%) in group I and one patient (1.5%) in group II, and these patients had to undergo invasive surgical procedures (hysterectomy). There was no statistically significant difference between the groups in terms of failed to reduce bleeding rates (p=0.52).
Conclusion: Keeping the Bakri balloon in place for longer than 12 hours does not provide favourable clinical outcomes compared to keeping in place for less than 12 hours.
References
- 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 (6): 323-33.
- Borovac-Pinheiro A, Pacagnella RC, Cecatti JG, Miller S, El Ayadi AM, Souza JP, et al. Postpartum hemorrhage: new sights for definition and diagnosis. Am J Obstet Gynecol. 2018; 219 (2): 162-8.
- Kong CW, To WWK. Menstrual and reproductive outcomes after use of balloon tamponade for severe postpartum hemorrhage. BMC Pregnancy Childbirth. 2018; 18 (1): 451.
- American College of Obstetricians and Gynecologists. ACOG Practice Bulletin: Clinical Management Guidelines for Obstetrician-Gynecologists Number 76, October 2006: postpartum hemorrhage. Obstet Gynecol. 2006; 108 (4): 1039-47.
- Nyfløt LT, Sandven I, Stray-Pedersen B, Pettersen S, Al-Zirqi I, Rosenberg M, et al. Risk factors for severe postpartum hemorrhage: a case-control study. BMC Pregnancy Childbirth. 2017; 17 (1): 17.
- 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 (3): 276-80.
- Evensen A, Anderson JM, Fontaine P. Postpartum Hemorrhage: Prevention and Treatment. Am Fam Physician. 2017; 95 (7): 442-9.
- Tahaoglu AE, Balsak D, Togrul C, Obut M, Tosun O, Cavus Y, et al. Emergency peripartum hysterectomy: our experience. Ir J Med Sci. 2016; 185 (4): 833-838.
- Revert M, Rozenberg P, Cottenet J, Quantin C. Intrauterine Balloon Tamponade for Severe Postpartum Hemorrhage. Obstet Gynecol. 2018; 131 (1): 143-9.
- Wright CE, Chauhan SP, Abuhamad AZ. Bakri balloon in the management of postpartum hemorrhage: a review. Am J Perinatol. 2014; 31 (11): 957-64.
- Einerson BD, Son M, Schneider P, Fields I, Miller ES. The association between intrauterine balloon tamponade duration and postpartum hemorrhage outcomes. Am J Obstet Gynecol. 2017; 216 (3): 300.e1-5.
- Revert M, Cottenet J, Raynal P, Cibot E, Quantin C, Rozenberg P. Intrauterine balloon tamponade for management of severe postpartum haemorrhage in a perinatal network: a prospective cohort study. BJOG. 2017; 124 (8): 1255-62.
- Dildy GA, Belfort MA, Adair CD, Destefano K, Robinson D, Lam G, et al. Initial experience with a dual-balloon catheter for the management of postpartum hemorrhage. Am J Obstet Gynecol. 2014; 210 (2): 136.e1-6.
- Wang D, Xu S, Qiu X, Zhu C, Li Z, Wang Z, et al. Early usage of Bakri postpartum balloon in the management of postpartum hemorrhage: a large prospective, observational multicenter clinical study in South China. J Perinat Med. 2018; 46 (6): 649-56.
- Rath W, Hackethal A, Bohlman MK. Second-line treatment of postpartum haemorrhage (PPH). Arch Gynecol Obstet. 2012; 286 (3): 549-61.
- Begley CM, Gyte GM, Devane D, McGuire W, Weeks A. Active versus expectant management for women in the third stage of labour. Cochrane Database Syst Rev. 2015; (3): CD007412. Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet Gynecol. 2017; 130 (4): e168-e186.
- Ahnfeldt-Mollerup P, Petersen LK, Kragstrup J, Christensen RD, Sørensen B. Postpartum infections: occurrence, healthcare contacts and association with breastfeeding. Acta Obstet Gynecol Scand. 2012; 91 (12): 1440-4.
- Darwish AM, Abdallah MM, Shaaban OM, Ali MK, Khalaf M, Sabra AMA. Bakri balloon versus condom-loaded Foley's catheter for treatment of atonic postpartum hemorrhage secondary to vaginal delivery: a randomized controlled trial. J Matern Fetal Neonatal Med. 2018; 31 (6): 747-53.
- Tahaoglu AE, Balsak D, Erdogdu E, Bakır MS, Aksin S, Bala M, et al. Bakri balloon placement effectively treats uterine atony and placenta previa. 2017; 31 (4): 795-9.
- Nelson WL, O'Brien JM. The uterine sandwich for persistent uterine atony: combining the B-Lynch compression suture and an intrauterine Bakri balloon. Am J Obstet Gynecol. 2007; 196 (5): e9-10.
- Gao Y, Wang Z, Zhang J, Wang D, Yin B, Zhu B. [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 (9): 670-5.
- Alouni S, Bedouet L, Ramos A, Ceccaldi C, Evrard ML, Khadre K. [Bakri balloon tamponade for severe post-partum haemorrhage: efficiency and fertility outcomes]. J Gynecol Obstet Biol Reprod (Paris). 2015; 44 (2): 171-5.
- Einerson BD, Son M, Schneider P, Fields I, Miller ES. The association between intrauterine balloon tamponade duration and postpartum hemorrhage outcomes. Am J Obstet Gynecol. 2017; 216 (3): 300.e1-e5.
- Grange J, Chatellier M, Chevé MT, Paumier A, Launay-Bourillon C, Legendre G, et al. Predictors of failed intrauterine balloon tamponade for persistent postpartum hemorrhge after vaginal delivery. PLoS One. 2018; 13 (10): e0206663.
Bakri balonun 12 saatten daha uzun süre uygulanması postpartum uterus atonisi tedavisinde olumlu klinik sonuçlar sağlar mı?
Abstract
Amaç: Uterin atonisi olan hastalarda başlangıçta uygulanan tedavi yöntemleri başarısız olursa, Bakri balonu gibi rahim içi tamponad cihazları kanamayı azaltmada etkin bir tedavi yöntemidir. Ancak, klinik uygulamada Bakri balonun uygulama süresi büyük değişkenlik göstermektedir ve bu konuda bir fikir birliği yoktur. Bu çalışmanın amacı, şiddetli postpartum hemorajisi olan hastalarda 12 saatten daha az veya daha fazla sürede çıkarılan Bakri balonun klinik sonuçlarını karşılaştırmaktır.
Gereç ve yöntem: Bu retrospektif çalışmaya vajinal doğumdan sonra şiddetli postpartum hemoraji nedeniyle Bakri balonu uygulanan 108 hasta dahil edildi. Hastalar Bakri balonun uygulama süresi 8-12 saat (Grup I) ve >12 saat (Grup II) olmak üzere iki gruba ayrıldı. Kanamanın durması ve hastanın ek cerrahi girişim gerektirmemesi durumunda Bakri balon uygulaması başarılı olarak kabul edildi. Grupların yaş, parite, gebelik haftası, kanamayı arttırabilecek ko-morbidite varlığı (çoğul gebelik, magnezyum sülfat infüzyonu), tahmini kan kaybı, doğum sonrası enfeksiyon, eritrosit ve taze donmuş plazma gereksinimi ve invaziv işlem gereksinimi karşılaştırıldı.
Bulgular: Grup I'de 26 hastaya (%52) eritrosit transfüzyonu, 18 hastaya (%36) eritrosit ve taze donmuş plazma (TDP) transfüzyonu yapıldı. Grup II'de 28 hastaya (%41,2) eritrosit transfüzyonu, 21 hastaya (%30,9) eritrosit ve TDP transfüzyonu yapıldı. Bu farklılıklar istatistiksel olarak anlamlı değildi (sırası ile, p=0.42 and p=0.21). Bakri balonu grup I'de 1 hastada (%2), grup II'de 1 hastada (%1,5) kanamayı azaltmada başarısız oldu ve bu hastalar invaziv cerrahi prosedüre (histerektomi) tabi tutuldu. Kanama oranlarını düşürmede başarısızlık açısından gruplar arasında istatistiksel olarak anlamlı bir farklılık yoktu (p=0.52).
Sonuç: Bakri balonun 12 saatten daha uzun süreli uygulanması, 12 saatten daha kısa süre ile uygulanması ile karşılaştırıldığında, olumlu klinik sonuçlar sağlamamaktadır.
References
- 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 (6): 323-33.
- Borovac-Pinheiro A, Pacagnella RC, Cecatti JG, Miller S, El Ayadi AM, Souza JP, et al. Postpartum hemorrhage: new sights for definition and diagnosis. Am J Obstet Gynecol. 2018; 219 (2): 162-8.
- Kong CW, To WWK. Menstrual and reproductive outcomes after use of balloon tamponade for severe postpartum hemorrhage. BMC Pregnancy Childbirth. 2018; 18 (1): 451.
- American College of Obstetricians and Gynecologists. ACOG Practice Bulletin: Clinical Management Guidelines for Obstetrician-Gynecologists Number 76, October 2006: postpartum hemorrhage. Obstet Gynecol. 2006; 108 (4): 1039-47.
- Nyfløt LT, Sandven I, Stray-Pedersen B, Pettersen S, Al-Zirqi I, Rosenberg M, et al. Risk factors for severe postpartum hemorrhage: a case-control study. BMC Pregnancy Childbirth. 2017; 17 (1): 17.
- 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 (3): 276-80.
- Evensen A, Anderson JM, Fontaine P. Postpartum Hemorrhage: Prevention and Treatment. Am Fam Physician. 2017; 95 (7): 442-9.
- Tahaoglu AE, Balsak D, Togrul C, Obut M, Tosun O, Cavus Y, et al. Emergency peripartum hysterectomy: our experience. Ir J Med Sci. 2016; 185 (4): 833-838.
- Revert M, Rozenberg P, Cottenet J, Quantin C. Intrauterine Balloon Tamponade for Severe Postpartum Hemorrhage. Obstet Gynecol. 2018; 131 (1): 143-9.
- Wright CE, Chauhan SP, Abuhamad AZ. Bakri balloon in the management of postpartum hemorrhage: a review. Am J Perinatol. 2014; 31 (11): 957-64.
- Einerson BD, Son M, Schneider P, Fields I, Miller ES. The association between intrauterine balloon tamponade duration and postpartum hemorrhage outcomes. Am J Obstet Gynecol. 2017; 216 (3): 300.e1-5.
- Revert M, Cottenet J, Raynal P, Cibot E, Quantin C, Rozenberg P. Intrauterine balloon tamponade for management of severe postpartum haemorrhage in a perinatal network: a prospective cohort study. BJOG. 2017; 124 (8): 1255-62.
- Dildy GA, Belfort MA, Adair CD, Destefano K, Robinson D, Lam G, et al. Initial experience with a dual-balloon catheter for the management of postpartum hemorrhage. Am J Obstet Gynecol. 2014; 210 (2): 136.e1-6.
- Wang D, Xu S, Qiu X, Zhu C, Li Z, Wang Z, et al. Early usage of Bakri postpartum balloon in the management of postpartum hemorrhage: a large prospective, observational multicenter clinical study in South China. J Perinat Med. 2018; 46 (6): 649-56.
- Rath W, Hackethal A, Bohlman MK. Second-line treatment of postpartum haemorrhage (PPH). Arch Gynecol Obstet. 2012; 286 (3): 549-61.
- Begley CM, Gyte GM, Devane D, McGuire W, Weeks A. Active versus expectant management for women in the third stage of labour. Cochrane Database Syst Rev. 2015; (3): CD007412. Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet Gynecol. 2017; 130 (4): e168-e186.
- Ahnfeldt-Mollerup P, Petersen LK, Kragstrup J, Christensen RD, Sørensen B. Postpartum infections: occurrence, healthcare contacts and association with breastfeeding. Acta Obstet Gynecol Scand. 2012; 91 (12): 1440-4.
- Darwish AM, Abdallah MM, Shaaban OM, Ali MK, Khalaf M, Sabra AMA. Bakri balloon versus condom-loaded Foley's catheter for treatment of atonic postpartum hemorrhage secondary to vaginal delivery: a randomized controlled trial. J Matern Fetal Neonatal Med. 2018; 31 (6): 747-53.
- Tahaoglu AE, Balsak D, Erdogdu E, Bakır MS, Aksin S, Bala M, et al. Bakri balloon placement effectively treats uterine atony and placenta previa. 2017; 31 (4): 795-9.
- Nelson WL, O'Brien JM. The uterine sandwich for persistent uterine atony: combining the B-Lynch compression suture and an intrauterine Bakri balloon. Am J Obstet Gynecol. 2007; 196 (5): e9-10.
- Gao Y, Wang Z, Zhang J, Wang D, Yin B, Zhu B. [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 (9): 670-5.
- Alouni S, Bedouet L, Ramos A, Ceccaldi C, Evrard ML, Khadre K. [Bakri balloon tamponade for severe post-partum haemorrhage: efficiency and fertility outcomes]. J Gynecol Obstet Biol Reprod (Paris). 2015; 44 (2): 171-5.
- Einerson BD, Son M, Schneider P, Fields I, Miller ES. The association between intrauterine balloon tamponade duration and postpartum hemorrhage outcomes. Am J Obstet Gynecol. 2017; 216 (3): 300.e1-e5.
- Grange J, Chatellier M, Chevé MT, Paumier A, Launay-Bourillon C, Legendre G, et al. Predictors of failed intrauterine balloon tamponade for persistent postpartum hemorrhge after vaginal delivery. PLoS One. 2018; 13 (10): e0206663.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | September 30, 2020 |
| Submission Date | December 26, 2019 |
| Published in Issue | Year 2020Volume: 59 Issue: 3 |
