How Is a Bakri Balloon Placed?

A Bakri balloon is used to stop excessive bleeding after childbirth.

A Bakri balloon is used in the management of excessive bleeding after childbirth (postpartum hemorrhage). Bakri balloon placement after vaginal delivery involves the following

• Before inserting the balloon, the physician ensures to empty the patient’s bladder by placing a Foley catheter.
• The physician inspects the uterine cavity (inside of the womb) to ensure that it is clear of placental remnants.
• Next, the physician cleanses the vagina and cervix with an antiseptic solution, such as povidone-iodine.
• After cleansing with an antiseptic solution, the physician grasps the cervix with forceps and inserts the balloon into the uterine cavity with the help of ultrasound. The entire portion of the balloon is pushed above the internal os (opening of the uterus).
• After the correct placement of the balloon, the physician inflates the balloon with a sterile saline solution using the enclosed syringe.
• To achieve the tamponade effect (maximum blockage), the physician applies gentle traction at the base of the balloon. The physician achieves the traction by placing weights not exceeding 500 g at the base of the balloon.
• A fluid-collecting bag is used to monitor hemostasis (stopping of blood flow). The balloon should remain inflated for 12 to 24 hours.

Bakri balloon placement after Cesarean delivery involves

• After the Cesarean delivery, the physician inserts the end of the catheter through the open uterine incision until it reaches the cervix and then advances it into the vagina.
• The physician closes the uterine incision while taking special care not to damage the balloon with the suturing needle.
• The physician inflates the balloon under direct examination.

Effectiveness of the balloon is measured using a tamponade test. This test is considered positive when sufficient hemostasis (cessation of blood loss) is achieved following the inflation of the balloon. Using a vaginal pack helps to maintain the balloon in the vagina and provides compression to the lower part of the uterus.

The physician may also recommend antibiotics to reduce the risk of infections.

Bakri balloon placement is a minimally invasive procedure to control uterine bleeding while conserving the mother’s child-bearing capacity. It is an effective and easy method of controlling uterine bleeding. The main advantages of Bakri balloon placement include

• Easy insertion of the balloon
• Easy removal without the need for an additional surgery
• Effectiveness of the device can be quickly determined
• Conservatively manages blood loss after childbirth
• Gives time for the physician to prepare for aggressive treatments

The complications of Bakri balloon include

• Uterine rupture (tear in the uterus)
• Balloon prolapse (slipping down of the balloon from its original position)
• Endometritis (inflammation of the endometrium)
• Blockage of blood supply in a blood vessel or heart when inflated with air or carbon dioxide

Bakri balloon placement is useful to control postpartum hemorrhage. Postpartum hemorrhage is a condition characterized by blood loss of more than 500 mL after vaginal childbirth or more than 1000 mL after Cesarean delivery within 24 hours. It is a second-line treatment for severe postpartum hemorrhage after the failure of other therapy and medications. It is indicated in

• Uterine atony in acute postpartum hemorrhage (failure of uterine contractions adequately following the delivery).
• Cesarean delivery due to placenta previa (the placenta covering the opening in the mother’s cervix) and a low-lying placenta.
• Acute or recurrent uterine inversion (failure of detachment of the placenta from the uterus).
• Secondary postpartum hemorrhage (postpartum hemorrhage that occurs 24 hours to 12 weeks after delivery).

Bakri balloon placement should be avoided in

• Infection of the vagina, uterus or cervix.
• Allergy to the components of the Bakri balloon.
• Suspected rupturing of the uterus.
• Retained products of conception.