Performance of Bakri balloon tamponade in controlling postpartum hemorrhage

Objective: Bakri balloon tamponade (BBT) is currently being used worldwide. This study aimed to explore the real-world performance of BBT for the treatment of postpartum hemorrhage (PPH). Methods: A total of 279 women with PPH who failed to respond to first-line conservative management and received BBT were consecutively recruited, reflecting authentic settings. The maternal baseline clinical data, PPH management, and perinatal outcome were recorded. In addition, the perinatal outcomes of women with pre-BBT blood loss < 1000 mL were compared to those with =1000 mL. Finally, the factors related to pre-BBT blood loss =1000 mL were analyzed by logistic regression. Results: The mean gestational age of all recruited women was 39.03 +/- 1.98 weeks, with a primipara proportion of 68.82%, a vaginal delivery rate of 60.93%, a uterine atony rate of 74.91%, and placenta accreta rate of 53.05%. Perinatal outcomes showed a hemostasis success rate of 88.89%, a transvaginal BBT placement rate of 80.29%, and a blood transfusion rate of 65.95%. Compared to women with blood loss < 1000 mL (33.33%), women with blood loss =1000 mL (66.67%) showed a lower proportion of gestational hypertension (P=0.026), cesarean section (P=0.024), a shorter time from delivery to insertion (P=0.037), and greater pre-BBT blood loss and blood transfusion (both P < 0.001). Notably, there were no significant differences in hemostasis success rate (P=0.346) or post-BBT blood loss (P=0.907). Delivery mode and uterine atony were closely correlated with pre-BBT blood loss. Conclusions: BBT is effective in stopping PPH among women with massive blood loss in documented settings.