The combination of intrauterine balloon tamponade and the B-Lynch procedure for the treatment of severe postpartum hemorrhage

doi:10.1016/j.ajog.2011.07.041

American Journal of Obstetrics and Gynecology

Volume 206, Issue 1, January 2012, Pages 65.e1-65.e4

https://doi.org/10.1016/j.ajog.2011.07.041 Get rights and content

Objective

To evaluate intrauterine balloon tamponade with or without B-Lynch sutures in avoiding postpartum hysterectomy in cases with severe postpartum hemorrhage.

Study Design

Retrospective analysis using all women delivering between January 2005 and July 2010 in our center. Prevention of hysterectomy was the main outcome studied.

Results

Twenty-four cases of severe postpartum hemorrhage occurred in which medical treatment alone failed. In 20 cases, the Bakri balloon was the first choice to stop hemorrhage. Sixty percent (n = 12) of these were successfully treated with the balloon alone, 30% (n = 6) with the balloon and the B-Lynch suture. Therefore, 90% (n = 18) were successfully treated with the balloon as part of the treatment. The balloon tamponade was not successful in 2 cases. Four cases were treated with emergency hysterectomy a priori.

Conclusion

The Bakri balloon with or without B-Lynch sutures in a stepwise approach is an effective option for the treatment of severe PPH.

Section snippets

Methods

This is a retrospective study of consecutive patients diagnosed to have a severe PPH and unsuccessful medical treatment with uterotonic agents who were subsequently treated with the Bakri balloon in our unit between January 2005 and July 2010. The cases were identified by review of medical records. This case series includes all cases of PPH managed with the uterine balloon tamponade (Bakri SOS balloon; Cook Woman's Health, Spencer, IN) after its introduction in our department in 2005. After

Results

During the study period, there were 9838 deliveries and the incidence of severe PPH unresponsive to standard medical treatment was 0.24% (n = 24/9838). The Bakri balloon tamponade was used in 20 cases (0.2% of all deliveries). The Table summarizes the clinical characteristics of the patients included in this report.

Estimated blood loss ranged from 800-8000 mL (median 2000) and patients received a median of 2.5 units of packed red blood cells (range, 0–26) and a median of 1 unit of fresh frozen

Comment

This study shows, that the Bakri balloon alone or in combination with B-Lynch sutures was effective in avoiding hysterectomy in 90% of cases with severe PPH, after cesarean section as well as after vaginal delivery.

Balloon tamponade may avoid the necessity for laparotomy after vaginal delivery as previously described.¹⁰ Even in those cases in which treatment with the Bakri balloon was unsuccessful, it did not result in a significant delay to the operating room and allowed enough time to

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Cited by (50)

Traditional uterine tamponade and vacuum-induced uterine tamponade devices in obstetrical hemorrhage management
2023, American Journal of Obstetrics and Gynecology MFM
Obstetrical hemorrhage is the leading cause of maternal morbidity and mortality worldwide, and the rates of severe hemorrhage are increasing. There is a crucial need to expand treatment options for hemorrhage to address this global crisis. Over the last decade, the evolution of hemorrhage control devices has contributed to advancements in obstetrical hemorrhage management. The number of existing hemorrhage control devices and techniques has increased markedly in recent years, and new devices are in development. The current evidence for established and investigational hemorrhage control devices has been summarized in this review. Of note, 2 main categories of devices exist: traditional uterine tamponade and vacuum-induced uterine tamponade. Although traditional intrauterine balloon tamponade devices are currently used widely in postpartum hemorrhage management, novel hemorrhage control devices and techniques have been developed. These include the minisponge tamponade device, the Jada System, a modified Bakri balloon technique, and a suction tube uterine tamponade technique. Reassuring safety data and preliminary efficacy data from pilot studies of these novel techniques support the powerful role intrauterine devices can play in obstetrical hemorrhage management. This review aimed to improve awareness of device options so that continued efforts can be made to integrate new technology into hemorrhage management protocols. Well-designed studies inclusive of new hemorrhage control devices are essential to understanding where new technology fits into preexisting obstetrical hemorrhage algorithms. In addition, access to new tamponade technology remains limited on a global scale. Programs aimed at both increasing access to devices and expanding educational initiatives are essential to make new technology a standard component for hemorrhage management.
Procedural techniques to control postpartum hemorrhage
2022, Best Practice and Research: Clinical Anaesthesiology
Citation Excerpt :
If this approach fails, radiological intervention or abdominal surgery should be performed without delay. For cesarean section, compression sutures should be considered rather than a uterine balloon, but both techniques can also be performed simultaneously [101–103]. For unstoppable bleeding, damage control surgery is mandatory as described below.
Postpartum hemorrhage can occur unexpectedly and with high dynamics. The mother’s life often depends on quick action and good communication within an interdisciplinary team. Knowledge of each other’s therapeutic options plays a major role. Treatment procedures include obstetric, surgical, and radiologic techniques. In addition to availability and experience with the techniques, two important aspects must be considered in the selection process: the type of delivery and the cause of the hemorrhage. In particular, the distinction between pregnancies with or without disturbed placentation from the placenta accreta spectrum is crucial. From these two points of view, we discuss here different uterus-preserving and uterus-removing techniques. We describe in detail the advantages and disadvantages of each procedure. Because most therapeutic options are based on small case series and uncontrolled studies, local circumstances and physician experience are critical in setting internal standards.
Uterine balloon tamponade for the treatment of postpartum hemorrhage: a systematic review and meta-analysis
2020, American Journal of Obstetrics and Gynecology
To assess the efficacy, effectiveness, and safety of uterine balloon tamponade for treating postpartum hemorrhage.
We searched electronic databases (from their inception to August 2019) and bibliographies. We included randomized controlled trials, nonrandomized studies, and case series that reported on the efficacy, effectiveness, and/or safety of uterine balloon tamponade in women with postpartum hemorrhage. The primary outcome was the success rate of uterine balloon tamponade for treating postpartum hemorrhage (number of uterine balloon tamponade success cases/total number of women treated with uterine balloon tamponade). For meta-analyses, we calculated pooled success rate for all studies, and relative risk with 95% confidence intervals for studies that included a comparative arm.
Ninety-one studies, including 4729 women, met inclusion criteria (6 randomized trials, 1 cluster randomized trial, 15 nonrandomized studies, and 69 case series). The overall pooled uterine balloon tamponade success rate was 85.9% (95% confidence interval, 83.9–87.9%). The highest success rates corresponded to uterine atony (87.1%) and placenta previa (86.8%), and the lowest to placenta accreta spectrum (66.7%) and retained products of conception (76.8%). The uterine balloon tamponade success rate was lower in cesarean deliveries (81.7%) than in vaginal deliveries (87.0%). A meta-analysis of 2 randomized trials that compared uterine balloon tamponade vs no uterine balloon tamponade in postpartum hemorrhage due to uterine atony after vaginal delivery showed no significant differences between the study groups in the risk of surgical interventions or maternal death (relative risk, 0.59; 95% confidence interval, 0.02–16.69). A meta-analysis of 2 nonrandomized before-and-after studies showed that introduction of uterine balloon tamponade in protocols for managing severe postpartum hemorrhage significantly decreased the use of arterial embolization (relative risk, 0.29; 95% confidence interval, 0.14–0.63). A nonrandomized cluster study reported that use of invasive procedures was significantly lower in the perinatal network that routinely used uterine balloon tamponade than that which did not use uterine balloon tamponade (3.0/1000 vs 5.1/1000; P < .01). A cluster randomized trial reported that the frequency of postpartum hemorrhage–related invasive procedures and/or maternal death was significantly higher after uterine balloon tamponade introduction than before uterine balloon tamponade introduction (11.6/10,000 vs 6.7/10,000; P = .04). Overall, the frequency of complications attributed to uterine balloon tamponade use was low (≤6.5%).
Uterine balloon tamponade has a high success rate for treating severe postpartum hemorrhage and appears to be safe. The evidence on uterine balloon tamponade efficacy and effectiveness from randomized and nonrandomized studies is conflicting, with experimental studies suggesting no beneficial effect, in contrast with observational studies. Further research is needed to determine the most effective programmatic and healthcare delivery strategies on uterine balloon tamponade introduction and use.
Intrauterine Bakri Balloon and Vaginal Tamponade Combined with Abdominal Compression for the Management of Postpartum Hemorrhage
2018, Journal of Obstetrics and Gynaecology Canada
This study sought to investigate the effect of Bakri balloon use and vaginal tamponade combined with abdominal compression for the management of postpartum hemorrhage (PPH).
This retrospective study reviewed cases of PPH in the International Peace Maternal and Child Health Hospital of China Welfare Institution in Shanghai, China from January 1, 2010 to December 31, 2015. A single use of the intrauterine Bakri balloon was applied in some cases, and additional vaginal tamponade combined with abdominal compression (double compression) was applied in other cases. The authors evaluated the effect of these two methods in the management of PPH.
The Bakri balloon was used in 305 cases of intrauterine PPH, and the clinical efficacy was 93.26%. One group of study patients underwent double compression, and these patients had a better clinical efficacy rate of 96.3% (157 of 163), whereas the efficacy in cases using the Bakri balloon alone (control group) was 87.3% (124 of 142). The postoperative complication rates of these two groups were 9.4% and 8.7%, respectively. Uterine arterial embolization was performed in patients in whom Bakri balloon use failed. None of the cases resulted in a hysterectomy.
Intrauterine Bakri balloon use combined with vaginal tamponade and abdominal compression is more effective in the treatment of PPH compared with Bakri balloon use alone. This method does not increase postoperative complications. Uterine atony with placenta previa or implantation may be possible reasons for noneffectiveness of Bakri balloon use.
FIGO good practice recommendations on surgical techniques to improve safety and reduce complications during cesarean delivery
2023, International Journal of Gynecology and Obstetrics
Peripartum Haemorrhage, Diagnosis and TherapyGuideline of the DGGG, OEGGG and SGGG (S2k, AWMF Registry No. 015-063, August 2022)
2023, Geburtshilfe und Frauenheilkunde

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: The authors report no conflict of interest.

: Reprints not available from the authors.

: Cite this article as: Diemert A, Ortmeyer G, Hollwitz B, et al. The combination of intrauterine balloon tamponade and the B-Lynch procedure for the treatment of severe postpartum hemorrhage. Am J Obstet Gynecol 2012;206:65.e1-4.

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ResearchObstetricsThe combination of intrauterine balloon tamponade and the B-Lynch procedure for the treatment of severe postpartum hemorrhage

Objective

Study Design

Results

Conclusion

Section snippets

Methods

Results

Comment

Int J Gynecol Obstet

Obstet Gynecol

Am J Obstet Gynecol

Int J Gynecol Obstet

Am J Obstet Gynecol

Am J Obstet Gynecol

Attending to 136 million births, every year: make every mother and child count: the world record 2005

Trends in adverse maternal outcome during childbirth

BMC Pregnancy Childbirth

Trends in postpartum hemorrhage: United States, 1994-2006

Am J Obstet Gynecol

ACOOAG. Postpartum hemorrhage. ACOG practice bulletin no. 76

Obstet Gynecol

Changing trends in peripartum hysterectomy over the last 4 decades

Am J Obstet Gynecol

Research
Obstetrics
The combination of intrauterine balloon tamponade and the B-Lynch procedure for the treatment of severe postpartum hemorrhage