Effectiveness of Intrauterine Bakri Balloon® Tamponade for Placenta Previa and Placenta Accreta Spectrum

Objective: To investigate the effectiveness and success rate of Bakri balloon tamponade (BBT) for postpartum haemorrhage (PPH) in patients with placenta previa and placenta accreta spectrum (PAS). Study Design: Descriptive study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Bursa Yuksek Ihtisas Education and Research Hospital, Bursa, Turkey, from June 2016 to June 2019. Methodology: Patients treated with BBT for severe PPH and uncontrollable bleeding due to treatment failure with uterotonic agents were retrospectively analysed. Exclusion criteria were age <18 years and >46 years, having multiple pregnancies, less amount of bleeding than indicated in the definition of PPH and requiring no BBT and those with hemodynamic instability before BBT requiring emergency postpartum hysterectomy, and having missing obstetric and laboratory data. The main outcome was the rate of surgical exploration and peripartum hysterectomy following the use of BBT as an adjunct treatment for refractory PPH. Secondary outcome was the need for blood transfusion. The BBT was considered to fail, if the bleeding from drainage catheter was continued and more than 100 mL during failure was 10 minutes. In case of BBT failure, C-section hysterectomy was performed. Results: Of the 128 patients, 14 (10.9%) had vaginal birth and 109 (85.2%) had Cesarean section delivery. Of patients with cesarean section delivery, 84 (65.6%) had multiple repeat cesarean deliveries and 22 (17.2%) were previous cesarean cases. Ninety-one patients (71.1%) had placental site abnormality. Twenty patients (15.6%) underwent hypogastric and uterine artery ligation. Eleven patients (8.7%) with persistent uterine bleeding and hemodynamic instability underwent hysterectomy. Success rate of BBT was found to be 91.3% in PPH. No mortality was observed. Conclusion: BBT is an effective tool for management of postpartum uterine atony and prevention of persistent PPH in patients with placenta previa and placenta accreta spectrum due to increased cesarean section and uterine surgeries in recent years.