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Bakri Balloon Placement Periprocedural Care

  • Author: Gabor C Mezei, MD, PhD; Chief Editor: Carl V Smith, MD  more...
 
Updated: Jul 06, 2016
 

Patient Education & Consent

Elements of informed consent

Given that PPH is a true medical emergency, informed consent is not a required part of management. However, if the patient is alert and able to communicate, an attempt of a quick verbal consent should be made.

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Pre-Procedure Planning

Prior to the procedure, a bedside ultrasound of the uterine cavity should be conducted to rule out retained product of conception and to assess the angulation and shape of the uterine cavity to guide balloon catheter placement.

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Equipment

The Bakri balloon or Bakri Postpartum Device[7] is a 100% silicone construction, dual channel balloon catheter specifically designed and approved by FDA for intrauterine placement in cases of PPH. The Bakri balloon contains no latex, and therefore can be safely used in patients with latex allergies. Its time-saving catheter is easy to place and monitor and rapidly achieves tamponade within the uterine cavity.

Compared to other similar devices, the Bakri balloon has a relatively large-bore drainage channel that allows for drainage in case of fibrin formation as well. It Includes a 60-mL syringe, intended for one-time use. The manufacturer-recommended volume is 500 mL; the length of catheter shaft is 43.5 cm, and the length of drainage tip is 3.6 cm. It does not contain insufflation valves. The catheter diameter is 24-F (8 mm).[7]

The Bakri balloon remains a successful method for postpartum hemorrhage management. Recent reports have confirmed previous study findings.[12, 13, 14, 15]

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Patient Preparation

Anesthesia

Intrauterine balloon tamponade may cause significant pain for the patient and, consequently, adequate analgesia is an important consideration. Although a strong epidural may address the initial hours of pain control in patients who undergo cesarean section or vaginal delivery, providing additional pain relief while the catheter is in place may be necessary later. The pain can be alleviated by reducing the insufflated balloon slightly. However, a balance must be achieved with respect to the tamponade effect and analgesia requirements.

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Monitoring & Follow-up

As stated in the device instructional booklet, patient monitoring is an integral part of managing PPH. Signs of a deteriorating or nonimproving condition should lead to a more aggressive treatment and management of patient uterine bleeding.

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Rate of Deflation

Manufacturers' package inserts state that the maximum in-dwelling time is 24 hours or less due to concerns about infection and tissue necrosis, but this time interval was not based on any data. The balloon is then deflated, either all at once or gradually over several hours, while monitoring the patient for recurrent bleeding. Emergency surgical services and experienced staff should be readily available when the balloon is deflated in case of recurrent hemorrhage.

If bleeding recurs during deflation or after removal, reinflation or reinsertion of the balloon should not be considered. Persistent or recurrent bleeding is an indication to proceed with other treatment options.

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Contributor Information and Disclosures
Author

Gabor C Mezei, MD, PhD Fellow in Maternal-Fetal Medicine, Clinical Instructor, Department of Obstetrics and Gynecology, The Milton S Hershey Medical Center, Pennsylvania State University College of Medicine

Gabor C Mezei, MD, PhD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Hungarian Medical Association of America, Society for Maternal-Fetal Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Serdar H Ural, MD Associate Professor of Obstetrics and Gynecology and Radiology, Director, Division of Maternal-Fetal Medicine, Medical Director, Labor and Delivery Suite, Pennsylvania State University College of Medicine

Serdar H Ural, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American Medical Association, Association of Professors of Gynecology and Obstetrics, AAGL, Society for Maternal-Fetal Medicine

Disclosure: Received honoraria from GSK for speaking and teaching; Received honoraria from J&J for speaking and teaching.

Specialty Editor Board

Jori S Carter, MD, MS Assistant Professor, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine

Jori S Carter, MD, MS is a member of the following medical societies: Alpha Omega Alpha, American College of Obstetricians and Gynecologists, Society of Gynecologic Oncology, Association of Women Surgeons, International Society for Magnetic Resonance in Medicine, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Chief Editor

Carl V Smith, MD The Distinguished Chris J and Marie A Olson Chair of Obstetrics and Gynecology, Professor, Department of Obstetrics and Gynecology, Senior Associate Dean for Clinical Affairs, University of Nebraska Medical Center

Carl V Smith, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, Association of Professors of Gynecology and Obstetrics, Central Association of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine, Council of University Chairs of Obstetrics and Gynecology, Nebraska Medical Association

Disclosure: Nothing to disclose.

References
  1. ACOG Practice Bulletin: Clinical Management Guidelines for Obstetrician-Gynecologists Number 76, October 2006: postpartum hemorrhage. Obstet Gynecol. 2006 Oct. 108(4):1039-47. [Medline].

  2. Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006 Apr 1. 367(9516):1066-74. [Medline].

  3. Lalonde A, Daviss BA, Acosta A, Herschderfer K. Postpartum hemorrhage today: ICM/FIGO initiative 2004-2006. Int J Gynaecol Obstet. 2006 Sep. 94(3):243-53. [Medline].

  4. Bakri YN, Amri A, Abdul Jabbar F. Tamponade-balloon for obstetrical bleeding. Int J Gynaecol Obstet. 2001 Aug. 74(2):139-42. [Medline].

  5. Georgiou C. Balloon tamponade in the management of postpartum haemorrhage: a review. BJOG. 2009 May. 116(6):748-57. [Medline].

  6. Lo A, St Marie P, Yadav P, Belisle E, Markenson G. The Impact of Bakri Balloon Tamponade on the Rate of Postpartum Hysterectomy for Uterine Atony. J Matern Fetal Neonatal Med. 2016 Jun 30. 1-15. [Medline].

  7. Bakri Postpartum Balloon product literature, Cook Medical Inc. Bloomington, IN, USA. www.cookmedical.com.

  8. BT-Cath [package insert]. Midvale, UT: Utah Medical Products, Inc. 2012. Available at [Full Text].

  9. Bakri YN. Use of intrauterine balloon catheters for control of uterine hemorrhage. UpToDate. 2012. [Full Text].

  10. Aggarwal N. The "tamponade test" in the management of massive postpartum hemorrhage. Obstet Gynecol. 2003 Sep. 102(3):641; author reply 641-2. [Medline].

  11. Vitthala S, Tsoumpou I, Anjum ZK, Aziz NA. Use of Bakri balloon in post-partum haemorrhage: a series of 15 cases. Aust N Z J Obstet Gynaecol. 2009 Apr. 49(2):191-4. [Medline].

  12. Stefanovic V, Grönvall M, Tikkanen M, Tallberg E, Paavonen J. Reply: Bakri balloon tamponade for postpartum hemorrhage. Acta Obstet Gynecol Scand. 2013 Sep. 92(9):1119. [Medline].

  13. Nesbitt A, Rai N, Limbu J, Leslie I, Yoong W. To tamponade or not to tamponade?. Acta Obstet Gynecol Scand. 2013 Sep. 92(9):1118-9. [Medline].

  14. 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 Apr. 92(4):433-8. [Medline].

  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 Oct. 207(4):281.e1-7. [Medline].

  16. 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 Aug. 62(8):540-7. [Medline].

  17. Dabelea V, Schultze PM, McDuffie RS Jr. Intrauterine balloon tamponade in the management of postpartum hemorrhage. Am J Perinatol. 2007 Jun. 24(6):359-64. [Medline].

  18. Johanson R, Kumar M, Obhrai M, Young P. Management of massive postpartum haemorrhage: use of a hydrostatic balloon catheter to avoid laparotomy. BJOG. 2001 Apr. 108(4):420-2. [Medline].

  19. Kaya B, Guralp O, Tuten A, Unal O, Celik MO, Dogan A. Which uterine sparing technique should be used for uterine atony during cesarean section? The Bakri balloon or the B-Lynch suture?. Arch Gynecol Obstet. 2016 Jan 18. [Medline].

  20. 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 Apr. 101(4):767-72. [Medline].

  21. Georgiou C. Intraluminal pressure readings during the establishment of a positive 'tamponade test' in the management of postpartum haemorrhage. BJOG. 2010 Feb. 117(3):295-303. [Medline].

  22. 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 May. 196(5):e9-10. [Medline].

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