How long is a Bakri balloon left in?
Postpartum hemorrhage (PPH) is a serious life-threatening complication of delivery. It can occur after vaginal or Cesarean delivery. It is associated with risks to the mother’s life. The Bakri balloon is indicated to manage postpartum hemorrhage occurring within 24 hours of delivery. This procedure is called intrauterine balloon tamponade. The balloon is inflated with about 500 ml of sterile liquid, such as sterile water, saline or Ringer's lactate solution. The Bakri balloon is left in the uterus for a maximum of 24 hours.
Based on the cause of postpartum hemorrhage, it is managed by several medical and conservative methods and invasive procedures. These include arterial embolization (block the artery to avoid bleeding); uterine compression sutures (stitch up the part of the womb that is bleeding) and uterine artery ligation (tie off the bleeding artery). A hysterectomy (surgical removal of the uterus) may be indicated if all other measures to control the bleeding fail. Intrauterine balloon tamponade has been found to be an effective, easily administered and minimally-invasive treatment option to control uterine bleeding. There are many types of balloons, including the Bakri balloon, BT-cath balloon tamponade catheter, Foley catheters, Rusch balloon, condom catheters and Sengstaken-Blakemore tube. The Bakri balloon and the BT-cath balloon tamponade catheter are the only ones that are specifically designed for postpartum hemorrhage. They are also the only devices approved by the United States Food and Drug Administration (FDA) for PPH.
Causes of postpartum hemorrhage
- Uterine atony (inability of the uterine muscles to contract): This is the most common cause of PPH (up to 80% of the cases).
- Retained placenta
- Rupture of uterus
- Genital tract trauma
- Clotting disorders
How is the Bakri balloon used?
The Bakri balloon is used for temporary control or reduction of postpartum hemorrhage when only conservative management of uterine bleeding is sufficient. Uterine atony is the most common indication for the Bakri balloon. Bleeding due to genital tract injury or retained product of conception is excluded before attempting Bakri balloon. When uterotonics (medications) and other medications fail to cause appropriate uterine contractions and reduce bleeding after delivery, the Bakri balloon can be effective in decreasing or arresting PPH.
The use of a Bakri balloon may be a successful and definite treatment in many cases, but may also serve as a temporary measure to decrease bleeding while waiting and preparing the mother for other definitive treatments like uterine artery ligation, uterine compression suture, hysterectomy or uterine artery embolization. A Bakri balloon may also be used to temporarily control bleeding if the patient needs to be transferred to another center with more resources and experience.
What are the advantages of the Bakri balloon?
Advantages of the Bakri balloon include
- It is made of silicone, which is a nonreactive material, and is beneficial to those with a latex allergy.
- The shape is similar to that of the normal uterine cavity.
- The risk of uterine perforation is lower.
- It comes presterilized. It is ready to use and quick to administer, hence saving time compared to other techniques.
When is the Bakri balloon not used?
The use of the Bakri balloon is contraindicated in the following conditions
- Heavy bleeding that requires more invasive treatments
- Cervical cancer
- Anatomical abnormalities of the uterus (abnormal structure)
- Uterine pathologies like fibroids that affect the shape and size of the uterus
- Uterine rupture or suspected rupture
- Genital tract injuries and bleeding from lacerations
- Infection of the reproductive tract
- Allergy to silicone (balloon material)
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