BAKRI BALLOON TAMPONADE IN OBSTETRIC HAEMORRHAGE: REVIEW IN UKM MEDICAL CENTRE

1. BAKRI BALLOON TAMPONADE IN OBSTETRIC HAEMORRHAGE: REVIEW IN UKM MEDICAL CENTRE AqmarS, NurAzurah AG, Rahana AR, Norazlin MI, MH Omar, MA Jamil. Department of Obstetrics & Gynaecology, UKM Medical Centre, UniversitiKebangsaan Malaysia. . OPTIONALLOGO HERE OPTIONALLOGO HERE Various method of removal has been reported inclusive of removing 5cc to 250 cc. Conclusion: Bakriballoon tamponade reported high success rate of almost eighty-percent. It is a reliable alternative in management of massive obstetrics hemorrhage following failure of first line uterotonic agents with avoidance of surgical intervention. References: 1.Wise A, Clark. Challenges of major obstetrics haemorrhage. Best Practice& Research clinical Obstetrics and Gynaecology 2010;24:353-365 2.Georgiou C. Balloon Tamponade in the management of postpartum haemorrhage: a review.BJOG 2009;116:748-757. 3.Vitthala S, TsoumpouI,Anjum Z et al. Use of Bakri balloon in postpartum haemorrhage: A series of 15 cases. ANZOG 2009;49:191-194 Methods and materials: A retrospective review of all obstetrics hemorrhage in UniversitiKebangsaan Malaysia Medical Centre (UKMMC) between 1st of January 2009 to 31st October 2011. Data collection was obtained from delivery and maternity operative records and patients’ medical records. All cases were unsuccessfully managed with first line uterotonic agents. Results: Fifty-six cases of obstetric hemorrhage were identified. Fourteen were managed with Bakri balloon. Seventy-nine percent (11) had bleeding successfully arrested with Bakri balloon tamponade. Two cases required emergencyperipartum hysterectomies and one failure of insertion. No maternal death reported. Mean age was 33.2 ± 4.7years and mean gestational age was 34.4±11.6weeks. Majority of massive hemorrhage was due to primary PPH (64%, n=9). Fifty percent were attributed to uterine atony followed by cervical laceration in two cases. Four delivered vaginally, one vacuum assisted delivery, six LSCS sections, three ERPOC. Mean blood loss prior to Bakri Balloon insertion was 1300±333ml. Total blood transfusion ranged from 500 to 5000mls. Mean volume of normal saline inflated was 285ml±145mls and mean balloon duration in situ was 24±16hours. All balloons insertions were by antegrade approach under ultrasound guidance. Three insertions were aided with uterine sounds and one balloon placement in the vagina has been ensured with use of tampon. Background: Significant obstetric hemorrhage is defined by blood loss of >1000mls following any antepartum, postpartum hemorrhage and bleeding from early pregnancy complications, while major loss exceeds 2500mls[1]. Recently, Bakri balloon tamponade has been shown to provide temporary reduction of postpartum uterine bleeding following unsuccessful management with uterotonic agents, repair of genital tract laceration or removal of retained product of conception, thus reducing the necessity for hysterectomy[2,3]. Objective:To determine the efficacy of Bakri balloon tamponade in management of obstetric hemorrhage with avoidance of hysterectomy and maternal death. References: Content goes here…