The Bakri balloon for the management of postpartum hemorrhage in cases with placenta previa Pınar Kumru a , Oya Demirci a , Emre Erdogdu a, *, Resul Arısoy a , Arif Aktug Ertekin b , Semih Tugrul a , Oya Pekin a a Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, Istanbul, Turkey b Uskudar University Obstetrics and Gynecology, Istanbul, Turkey 1. Introduction Postpartum hemorrhage (PPH) is a major cause of pregnan- cy-related death in both developed and developing countries [1]. The incidence of atony has been reduced by intrapartum care, but because of increasing cesarean section (CS) rates, hemorrhage originating from the placental implantation site due to placenta previa remains a serious obstetric complication with maternal mortality and morbidity [2–4]. Patients with placenta previa are at a significant risk of high intraoperative blood loss due to the possibility of the obstetrician incising through the placenta and the increased risk of placenta accreta. In addition, the uterine site of abnormal implantation does not contract as effectively as a normal uterine segment. For these reasons, we need to improve our ability to respond to this obstetric emergency. One of those improvements in care is the Bakri balloon, which is one of the most important recent advances for treating serious PPH. The aim of the present study was to evaluate the success rate of the Bakri balloon in the event of uncontrollable hemorrhage due to placenta previa. 2. Materials and methods This is a retrospective study of 25 patients who were treated with the Bakri balloon (Cook Women’s Health, Spencer, IN, USA), diagnosed to have severe PPH with placenta previa and failed medical treatment with uterotonic agents in our unit between February 2009 and February 2012. PPH was defined as >1000 ml estimated blood loss after CS [5]. The cases were identified by review of medical records. For maternal demographic data medical records were received to assess the following: age, parity, gestational age, previous abortions and dilatation and curettage. Pre-operative and postoperative hemoglobin, hemato- crit, thrombocyte count, operation length, need for and number of transfusions, balloon tamponide time, postoperative hospitaliza- tion time, need for high dependency unit care and complications were detected. Risk factors for PPH; previous CS, number of previous CS and current placenta previa were identified from the medical records. Balloon insertion was done transvaginally or transabdominally. Transabdominal insertion of the balloon was performed by passing the distal and of the balloon shaft through the cervix with an assistant pulling vaginally. After checking the position of the balloon, the uterine incision was closed. The balloon was filled with an amount of saline ranging from 130 to 500 ml depending on the size and capacity of uterus. A collection bag was used to follow European Journal of Obstetrics & Gynecology and Reproductive Biology 167 (2013) 167–170 A R T I C L E I N F O Article history: Received 17 July 2012 Received in revised form 5 November 2012 Accepted 30 November 2012 Keywords: Bakri balloon Postpartum hemorrhage Placenta previa Cesarean A B S T R A C T Objective: To evaluate the success rate of the Bakri balloon in the event of uncontrollable hemorrhage due to placenta previa. Study design: We evaluated 25 patients who were treated with the Bakri balloon who had severe postpartum hemorrhage with placenta previa and failed medical treatment with uterotonic agents. Results: The Bakri balloon was inserted abdominally during cesarean section in 24 of 25 cases. In only one case was it inserted vaginally. The Bakri tamponade was effective in 22 cases (88%). There were three cases with failure: two patients needed an additional procedure (hypogastric artery ligation and B-Lynch suture) and one patient needed hysterectomy. Conclusions: The Bakri balloon is the least invasive, rapid method in the management of bleeding due to placenta previa with minimal complications. ß 2012 Elsevier Ireland Ltd. All rights reserved. * Corresponding author. Tel.: +90 05053842092. E-mail address: emreerd@yahoo.com (E. Erdogdu). Contents lists available at SciVerse ScienceDirect European Journal of Obstetrics & Gynecology and Reproductive Biology jou r nal h o mep ag e: w ww .elsevier .co m /loc ate/ejo g rb 0301-2115/$ – see front matter ß 2012 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ejogrb.2012.11.025