Intrauterine balloon tamponade for control of postpartum hemorrhage
- Younes N Bakri, MD
Younes N Bakri, MD
- Professor of Obstetrics & Gynecology
- Director of Gynecologic Oncology
- Mercer University School of Medicine
- Medical Center of Central Georgia
- Sabaratnam Arulkumaran, PhD, DSc, FRCS, FRCOG
Sabaratnam Arulkumaran, PhD, DSc, FRCS, FRCOG
- Professor Emeritus
- Obstetrics and Gynaecology
- St George’s University of London
Postpartum hemorrhage is an obstetrical emergency that can follow vaginal or cesarean delivery. It is one of the leading causes of maternal mortality, especially in the developing world . Early use of intrauterine balloon tamponade is a way of limiting ongoing uterine blood loss while initiating other measures, and can be readily implemented by providers with minimal training. It can be a life-saving intervention, especially in low-resource settings where blood transfusion and surgical facilities may not be available . Multiple types of balloons catheters are available for uterine tamponade. It is prudent to include one of these devices in postpartum hemorrhage kits.
This topic will discuss the use of intrauterine balloon catheters in the management of postpartum hemorrhage. Detailed information on medical and surgical treatments for postpartum hemorrhage, as well as the causes, can be found separately. (See "Overview of postpartum hemorrhage" and "Management of postpartum hemorrhage at vaginal delivery" and "Management of postpartum hemorrhage at cesarean delivery".)
Use of balloon tamponade and other interventions for management of acute severe menorrhagia are reviewed separately. (See "Managing an episode of severe or prolonged uterine bleeding".)
TYPES OF BALLOON CATHETERS
The following balloon catheters were specifically designed for placement in the uterus for control of postpartum hemorrhage:
●Bakri tamponade balloon catheter – The Bakri tamponade balloon catheter consists of a silicone balloon (picture 1) (maximum recommended fill volume 500 mL, but volumes up to 1300 mL have been used ) connected to a 24 French silicone catheter 54 cm in length. The collapsed balloon is inserted into the uterus (figure 1); when filled with fluid, the balloon adapts to the configuration of the uterine cavity to tamponade endometrial bleeding. The central lumen of the catheter allows drainage and is designed to monitor ongoing bleeding above the level of the balloon (figure 2). The device is intended for one-time use.
- Khan KS, Wojdyla D, Say L, et al. WHO analysis of causes of maternal death: a systematic review. Lancet 2006; 367:1066.
- Tindell K, Garfinkel R, Abu-Haydar E, et al. Uterine balloon tamponade for the treatment of postpartum haemorrhage in resource-poor settings: a systematic review. BJOG 2013; 120:5.
- Kaya B, Tuten A, Daglar K, et al. Balloon tamponade for the management of postpartum uterine hemorrhage. J Perinat Med 2014; 42:745.
- Bakri YN. Uterine tamponade-drain for hemorrhage secondary to placenta previa-accreta. Int J Gynaecol Obstet 1992; 37:302.
- Rathore AM, Gupta S, Manaktala U, et al. Uterine tamponade using condom catheter balloon in the management of non-traumatic postpartum hemorrhage. J Obstet Gynaecol Res 2012; 38:1162.
- Thapa K, Malla B, Pandey S, Amatya S. Intrauterine condom tamponade in management of post partum haemorrhage. J Nepal Health Res Counc 2010; 8:19.
- Airede LR, Nnadi DC. The use of the condom-catheter for the treatment of postpartum haemorrhage - the Sokoto experience. Trop Doct 2008; 38:84.
- Akhter S, Begum MR, Kabir Z, et al. Use of a condom to control massive postpartum hemorrhage. MedGenMed 2003; 5:38.
- Sinha SM. The "tamponade test" in the management of massive postpartum hemorrhage. Obstet Gynecol 2003; 102:641; author reply 641.
- Georgiou C. Intraluminal pressure readings during the establishment of a positive 'tamponade test' in the management of postpartum haemorrhage. BJOG 2010; 117:295.
- 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:e9.
- Belfort MA, Dildy GA, Garrido J, White GL. Intraluminal pressure in a uterine tamponade balloon is curvilinearly related to the volume of fluid infused. Am J Perinatol 2011; 28:659.
- Georgiou C. Balloon tamponade in the management of postpartum haemorrhage: a review. BJOG 2009; 116:748.
- Bakri YN, Amri A, Abdul Jabbar F. Tamponade-balloon for obstetrical bleeding. Int J Gynaecol Obstet 2001; 74:139.
- 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; 49:191.
- Dabelea V, Schultze PM, McDuffie RS Jr. Intrauterine balloon tamponade in the management of postpartum hemorrhage. Am J Perinatol 2007; 24:359.
- Soleymani Majd H, Pilsniak A, Reginald PW. Recurrent uterine inversion: a novel treatment approach using SOS Bakri balloon. BJOG 2009; 116:999.
- Kaya B, Tüten A, Çelik H, et al. Non-invasive management of acute recurrent puerperal uterine inversion with Bakri postpartum balloon. Arch Gynecol Obstet 2014; 289:695.
- Timor-Tritsch IE, Cali G, Monteagudo A, et al. Foley balloon catheter to prevent or manage bleeding during treatment for cervical and Cesarean scar pregnancy. Ultrasound Obstet Gynecol 2015; 46:118.
- Condous GS, Arulkumaran S, Symonds I, et al. The "tamponade test" in the management of massive postpartum hemorrhage. Obstet Gynecol 2003; 101:767.
- Grönvall M, Tikkanen M, Tallberg E, et al. 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; 92:433.
- 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; 62:540.
- Laas E, Bui C, Popowski T, et al. 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; 207:281.e1.
- Vintejoux E, Ulrich D, Mousty E, et al. Success factors for Bakri™ balloon usage secondary to uterine atony: a retrospective, multicentre study. Aust N Z J Obstet Gynaecol 2015; 55:572.
- Dildy GA, Belfort MA, Adair CD, et al. Initial experience with a dual-balloon catheter for the management of postpartum hemorrhage. Am J Obstet Gynecol 2014; 210:136.e1.
- Majumdar A, Saleh S, Davis M, et al. Use of balloon catheter tamponade for massive postpartum haemorrhage. J Obstet Gynaecol 2010; 30:586.
- Leparco S, Viot A, Benachi A, Deffieux X. Migration of Bakri balloon through an unsuspected uterine perforation during the treatment of secondary postpartum hemorrhage. Am J Obstet Gynecol 2013; 208:e6.
- Goorah B, Tulandi T. Uterine rupture resulting from the pressure of an intrauterine balloon. J Obstet Gynaecol Can 2009; 31:649.
- Wu HH, Yeh GP, Hsieh TC. Iatrogenic uterine rupture caused by overinflation of RUMI manipulator balloon. J Minim Invasive Gynecol 2005; 12:174.
- Vlahos NP, Bankowski BJ, Makrakis E. Non-puerperal uterine rupture after use of misoprostol and a Foley catheter for management of uterine bleeding. Int J Gynaecol Obstet 2005; 88:331.
- Price N, Whitelaw N, B-Lynch C. Application of the B-Lynch brace suture with associated intrauterine balloon catheter for massive haemorrhage due to placenta accreta following a second-trimester miscarriage. J Obstet Gynaecol 2006; 26:267.
- 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.
- Gottlieb AG, Pandipati S, Davis KM, Gibbs RS. Uterine necrosis: a complication of uterine compression sutures. Obstet Gynecol 2008; 112:429.
- B-Lynch C. Partial ischemic necrosis of the uterus following a uterine brace compression suture. BJOG 2005; 112:126.
- Joshi VM, Shrivastava M. Partial ischemic necrosis of the uterus following a uterine brace compression suture. BJOG 2004; 111:279.
- Reyftmann L, Nguyen A, Ristic V, et al. [Partial uterine wall necrosis following Cho hemostatic sutures for the treatment of postpartum hemorrhage]. Gynecol Obstet Fertil 2009; 37:579.
- El-Hamamy E. Partial ischemic necrosis of the uterus following a uterine brace compression suture. BJOG 2005; 112:126.
- Pechtor K, Richards B, Paterson H. Antenatal catastrophic uterine rupture at 32 weeks of gestation after previous B-Lynch suture. BJOG 2010; 117:889.
- Fotopoulou C, Dudenhausen JW. Uterine compression sutures for preserving fertility in severe postpartum haemorrhage: an overview 13 years after the first description. J Obstet Gynaecol 2010; 30:339.
- Mallappa Saroja CS, Nankani A, El-Hamamy E. Uterine compression sutures, an update: review of efficacy, safety and complications of B-Lynch suture and other uterine compression techniques for postpartum haemorrhage. Arch Gynecol Obstet 2010; 281:581.
- TYPES OF BALLOON CATHETERS
- MECHANISM OF ACTION
- INDICATIONS AND CONTRAINDICATIONS
- After vaginal delivery
- After cesarean delivery
- PERIPROCEDURE MONITORING AND CARE
- SUCCESS RATE
- Comparison with other methods
- OTHER APPROACHES
- External compression plus internal tamponade
- Uterine vessel ligation plus internal tamponade
- SUMMARY AND RECOMMENDATIONS