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Germano C, Girlando F, Carosso AR, Messina A, Parpinel G, Leo L, Attini R, Revelli A, Masturzo B. Uterine Balloon Tamponade under Ultrasound Guidance in Women with Postpartum Hemorrhage: A Retrospective Cohort Study. J Clin Med 2024; 13:2632. [PMID: 38731162 PMCID: PMC11084657 DOI: 10.3390/jcm13092632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/15/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Postpartum hemorrhage (PPH) represents one of the principal causes of maternal mortality and morbidity worldwide. Uterine balloon tamponade (UBT) is recommended for the treatment of postpartum hemorrhage due to uterine atony in women who do not respond to pharmacological first-line treatment. The success of UBT in bleeding control is related to the correct positioning of the device, since incorrect insertion can be associated with ineffectiveness and requires time-consuming repositioning maneuvers, with a further increase in blood loss. The use of ultrasound (US) during UBT may increase the success rate by preventing wrong positioning. This study aims to demonstrate the role of US guidance during UBT and to assess whether US guidance can ease positioning and reduce insertion times, preventing additional repositioning maneuvers, in comparison with a US check carried out after balloon insertion. Methods: This was a retrospective study including 370 women who underwent vaginal delivery, had PPH caused by uterine atony and required UBT at Sant'Anna Hospital from 2015 to 2019. The exclusion criteria were an abnormal placental site, vaginal or cervical trauma, coagulation defects, uterine anomalies, previous postpartum hemorrhage and previous caesarean section. Included subjects were divided into two groups: the US-guided group (n = 200) underwent Bakri balloon positioning under US guidance, and the non-guided group (n = 170) received a US check only after balloon insertion. The primary outcome was the success rate of the procedure, expressed as the percentage of cases with bleeding control without the need for balloon repositioning; the secondary outcomes were the length of the procedure and some parameters related to blood loss. Results: The success rate was 99% for the US-guided group vs. 86% for the non-guided group. None of the patients required hysterectomy. In the US-guided group with respect to the non-guided group, we observed a significant reduction in blood loss (1100 ± 450 vs. 1500 ± 600 mL; p < 0.001), Δhemoglobin level (1.8 ± 1.1 vs. 2.7 ± 2.0 g/dL, p < 0.001) and time required for the procedure (8 vs. 13 min, p < 0.001). Conclusions: Our data suggest that the use of US guidance for placement of UBT was associated with reduced need for balloon repositioning, lower blood loss, and faster resolution of postpartum hemorrhage.
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Affiliation(s)
- Chiara Germano
- Department of Obstetrics and Gynecology, Nuovo Ospedale degli Infermi, 13875 Biella, Italy; (G.P.); (R.A.); (B.M.)
| | - Flavia Girlando
- SCDU2, Department of Surgical Sciences, Sant’Anna Hospital, University of Turin, 10126 Turin, Italy; (F.G.); (A.R.C.); (A.M.); (A.R.)
| | - Andrea Roberto Carosso
- SCDU2, Department of Surgical Sciences, Sant’Anna Hospital, University of Turin, 10126 Turin, Italy; (F.G.); (A.R.C.); (A.M.); (A.R.)
| | - Alessandro Messina
- SCDU2, Department of Surgical Sciences, Sant’Anna Hospital, University of Turin, 10126 Turin, Italy; (F.G.); (A.R.C.); (A.M.); (A.R.)
| | - Giulia Parpinel
- Department of Obstetrics and Gynecology, Nuovo Ospedale degli Infermi, 13875 Biella, Italy; (G.P.); (R.A.); (B.M.)
| | - Livio Leo
- Department of Obstetrics and Gynecology, Beauregard Hospital, 11100 Aosta, Italy;
| | - Rossella Attini
- Department of Obstetrics and Gynecology, Nuovo Ospedale degli Infermi, 13875 Biella, Italy; (G.P.); (R.A.); (B.M.)
| | - Alberto Revelli
- SCDU2, Department of Surgical Sciences, Sant’Anna Hospital, University of Turin, 10126 Turin, Italy; (F.G.); (A.R.C.); (A.M.); (A.R.)
| | - Bianca Masturzo
- Department of Obstetrics and Gynecology, Nuovo Ospedale degli Infermi, 13875 Biella, Italy; (G.P.); (R.A.); (B.M.)
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Futcher F, Moufawad G, Centini G, Hayek J, Tarchichi J, Bakar J, Habib N. Intrauterine Tamponade Balloon for Management of Severe Postpartum Haemorrhage: Does Early Insertion Change the Outcome? A Retrospective Study on Blood Loss. J Clin Med 2023; 12:5439. [PMID: 37685506 PMCID: PMC10487974 DOI: 10.3390/jcm12175439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 09/10/2023] Open
Abstract
The French College of Gynecologists and Obstetricians (CNGOF) recommends the use of intrauterine tamponade balloon (IUTB) in postpartum haemorrhage for bleeding that is refractory after sulprostone before either surgery or interventional radiology. However, the elapsed time between uterotonic drug injection and the insertion of intrauterine tamponade balloon was not reliably assessed. OBJECTIVE To evaluate the role of the timing of IUTB insertion and to assess the correlation between the time of insertion and outcome. METHODS A retrospective study in two tertiary care centres, including patients transferred for severe PPH management. RESULTS A total of 81 patients were included: 52 patients with IUTB inserted before 15 min (group 1) and 29 patients with IUTB inserted after 15 min (group 2). The mean volume of blood loss in the group of patients with IUTB inserted before 15 min was significantly lower than in group of patients with IUTB set after 15 min. CONCLUSION An IUTB could be inserted simultaneously with a uterotonic agent, within 15 min and not after 15 min as suggested by local guidelines, but further prospective studies are required to confirm this.
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Affiliation(s)
- Françoise Futcher
- Department of Obstetrics and Gynecology, Moulins-Yzeure Hospital, 10 Av. du Général de Gaulle, 03006 Moulins, France;
| | - Graziella Moufawad
- Department of Obstetrics and Gynecology, Francois Quesnay Hospital, 78201 Mantes-la-Jolie, France; (G.M.); (J.H.); (J.T.); (J.B.)
| | - Gabriele Centini
- Department of Molecular and Reproductive Medicine, University of Siena, 53100 Siena, Italy;
| | - Jad Hayek
- Department of Obstetrics and Gynecology, Francois Quesnay Hospital, 78201 Mantes-la-Jolie, France; (G.M.); (J.H.); (J.T.); (J.B.)
| | - Jana Tarchichi
- Department of Obstetrics and Gynecology, Francois Quesnay Hospital, 78201 Mantes-la-Jolie, France; (G.M.); (J.H.); (J.T.); (J.B.)
| | - Joseph Bakar
- Department of Obstetrics and Gynecology, Francois Quesnay Hospital, 78201 Mantes-la-Jolie, France; (G.M.); (J.H.); (J.T.); (J.B.)
| | - Nassir Habib
- Department of Obstetrics and Gynecology, Francois Quesnay Hospital, 78201 Mantes-la-Jolie, France; (G.M.); (J.H.); (J.T.); (J.B.)
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Spencer NR, Saad A. How did a Bakri balloon enter the broad ligament? Am J Obstet Gynecol 2021; 225:700. [PMID: 34453933 DOI: 10.1016/j.ajog.2021.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
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4
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The Discriminant Use of Intrauterine Balloon Tamponade and Compression Sutures for Management of Major Postpartum Hemorrhage: Comparison of Patient Characteristics and Clinical Outcome. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6648829. [PMID: 33490275 PMCID: PMC7801069 DOI: 10.1155/2021/6648829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 11/17/2022]
Abstract
Background Intrauterine balloon tamponade (IUBT) and compression sutures have been widely used in recent years in the management of postpartum hemorrhage (PPH). However, there is scant literature directly comparing the clinical scenarios that led to the discriminant selection of these management modalities and the direct clinical outcomes. The purpose of this study is to compare the patient characteristics and clinical risk factors that led to the use of IUBT and compression sutures in the management of major PPH as well as the immediate outcome in a retrospective cohort. Methods Patients who had IUBT or compression sutures applied due to major PPH (>1000 ml) from 2014 to 2018 in a single obstetric unit were recruited. The patient characteristics and clinical outcome of the two groups were compared. Results A total of 67 patients had IUBT and 29 patients had compression sutures applied as the first uterine sparing technique. Apart from more vaginal deliveries (25.4% vs. 3.5%) in the IUBT group compared to compression sutures, there were no significant differences between the two groups in terms of patient characteristics. The IUBT group had a slightly higher blood loss at the start of the uterine sparing procedure (239 ml, p = 0.049) and received more transfusions, despite no differences in the total blood loss, hemogloblin level, incidence of coagulopathy, and intensive care unit admission between the two groups. There was no significant difference in the overall success rate between IUBT and compression sutures to control PPH without additional surgical intervention or hysterectomy (73.1% vs. 55.1%, p = 0.15) or the success rate for PPH due to uterine atony (32.8% vs. 20.7%), though IUBT apparently performed better than compression sutures in cases of placenta praevia (77.3% vs. 16.7%, p = 0.01). Blood loss > 1.5 l at the start of the procedure, presence of placenta accreta, and presence of coagulopathy were found to be significant poor prognostic factors for both procedures to control PPH. Conclusions There were no dominating patient characteristics that favoured the selection of either IUBT or compression sutures in the management of severe PPH except for the mode of delivery. Both procedures had equally high overall success rates to control PPH, but IUBT performed better in placenta praevia cases as compared to compression sutures.
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Soued M, Vivanti AJ, Smiljkovski D, Deffieux X, Benachi A, Le Gouez A, Mercier FJ. Efficacy of Intra-Uterine Tamponade Balloon in Post-Partum Hemorrhage after Cesarean Delivery: An Impact Study. J Clin Med 2020; 10:jcm10010081. [PMID: 33379355 PMCID: PMC7795364 DOI: 10.3390/jcm10010081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/20/2020] [Accepted: 12/23/2020] [Indexed: 11/16/2022] Open
Abstract
Invasive therapies (surgery or radiological embolization) are used to control severe post-partum hemorrhage. The intra-uterine tamponade balloon is a potential alternative, well documented after vaginal delivery. However, available data on its use after cesarean delivery remain scarce. This study assessed the efficacy of the intra-uterine tamponade balloon during post-partum hemorrhage in a cesarean delivery setting. Using a retrospective impact design, post-partum hemorrhage-related outcomes before (“pre-balloon” period) versus after implementation of intra-uterine tamponade balloon (“post-balloon” period) were compared. All women with post-partum hemorrhage requiring potent uterotonic treatment with prostaglandins after cesarean delivery over a 9-year period were eligible. The primary outcome was the rate of invasive procedure (conservative surgery, radiological embolization and/or hysterectomy). p < 0.05 was considered statistically significant. A total of 279 patients were included (140 vs. 139). Most baseline characteristics were comparable between the two studied periods. The success rate of the intra-uterine tamponade balloon was 82%, and no related complications occurred. Rates of invasive procedures and transfusion were significantly reduced (28.6% vs. 11.5%, p < 0.001 and 44.3% vs. 28.1%, p = 0.006 respectively) during the “post-balloon” period, and length of hospital stay was shorter (p < 0.001). Implementation of intra-uterine tamponade balloon during post-partum hemorrhage after cesarean delivery appears to be safe and effective, with a decrease in both invasive procedures and transfusion rates.
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Affiliation(s)
- Mickaël Soued
- Department of Anesthesia, Hôpital Antoine Béclère, APHP, Université Paris Saclay, 157 rue de la Porte de Trivaux, 92140 Clamart, France; (D.S.); (A.L.G.); (F.J.M.)
- Correspondence:
| | - Alexandre J. Vivanti
- Department of Gynecology and Obstetrics, Hôpital Antoine Béclère, APHP, Université Paris Saclay, 157 rue de la Porte de Trivaux, 92140 Clamart, France; (A.J.V.); (X.D.); (A.B.)
| | - Daniel Smiljkovski
- Department of Anesthesia, Hôpital Antoine Béclère, APHP, Université Paris Saclay, 157 rue de la Porte de Trivaux, 92140 Clamart, France; (D.S.); (A.L.G.); (F.J.M.)
| | - Xavier Deffieux
- Department of Gynecology and Obstetrics, Hôpital Antoine Béclère, APHP, Université Paris Saclay, 157 rue de la Porte de Trivaux, 92140 Clamart, France; (A.J.V.); (X.D.); (A.B.)
| | - Alexandra Benachi
- Department of Gynecology and Obstetrics, Hôpital Antoine Béclère, APHP, Université Paris Saclay, 157 rue de la Porte de Trivaux, 92140 Clamart, France; (A.J.V.); (X.D.); (A.B.)
| | - Agnès Le Gouez
- Department of Anesthesia, Hôpital Antoine Béclère, APHP, Université Paris Saclay, 157 rue de la Porte de Trivaux, 92140 Clamart, France; (D.S.); (A.L.G.); (F.J.M.)
| | - Frédéric J. Mercier
- Department of Anesthesia, Hôpital Antoine Béclère, APHP, Université Paris Saclay, 157 rue de la Porte de Trivaux, 92140 Clamart, France; (D.S.); (A.L.G.); (F.J.M.)
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Kobayashi T, Tanaka T, Kawata M, Oguma K, Ito S, Matsuzawa N, Murase Y, Yata S, Tanaka S, Kaneda H. Intrauterine gauze or balloon tamponade for the management of postpartum hemorrhage due to uterine atony during maternal transportation. HYPERTENSION RESEARCH IN PREGNANCY 2020. [DOI: 10.14390/jsshp.hrp2020-003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Toru Kobayashi
- Department of Obstetrics and Gynecology, Juntendo University Shizuoka Hospital
| | - Toshitaka Tanaka
- Department of Obstetrics and Gynecology, Juntendo University Shizuoka Hospital
| | - Misato Kawata
- Department of Obstetrics and Gynecology, Juntendo University Shizuoka Hospital
| | - Kyoko Oguma
- Department of Obstetrics and Gynecology, Juntendo University Shizuoka Hospital
| | - Saki Ito
- Department of Obstetrics and Gynecology, Juntendo University Shizuoka Hospital
| | - Nana Matsuzawa
- Department of Obstetrics and Gynecology, Juntendo University Shizuoka Hospital
| | - Yoshiko Murase
- Department of Obstetrics and Gynecology, Juntendo University Shizuoka Hospital
| | - Shotaro Yata
- Department of Obstetrics and Gynecology, Juntendo University Shizuoka Hospital
| | - Satomi Tanaka
- Department of Obstetrics and Gynecology, Juntendo University Shizuoka Hospital
| | - Hiroshi Kaneda
- Department of Obstetrics and Gynecology, Juntendo University Shizuoka Hospital
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Nagase Y, Matsuzaki S, Kawanishi Y, Nakagawa S, Kakigano A, Takiuchi T, Mimura K, Tomimatsu T, Endo M, Kimura T. Efficacy of Prophylactic Antibiotics in Bakri Intrauterine Balloon Placement: A Single-Center Retrospective Analysis and Literature Review. AJP Rep 2020; 10:e106-e112. [PMID: 32206439 PMCID: PMC7082208 DOI: 10.1055/s-0040-1708487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 11/15/2019] [Indexed: 11/07/2022] Open
Abstract
Objective Bakri intrauterine balloon (BIUB) placement is an effective treatment for postpartum hemorrhage (PPH). This study aims to evaluate the risk of infection during BIUB placement. Study Design Data for all deliveries ( n = 2,144) at our institution between January 2014 and March 2018 were retrospectively reviewed. Patients diagnosed with PPH ( n = 758) were included in our analysis, further divided into BIUB ( n = 80) and non-BIUB groups ( n = 678), and subdivided into vaginal delivery (VD), elective cesarean delivery (CD), and emergency CD groups. Postpartum endometritis rate was compared in each group. A single dose of prophylactic antibiotics was administered for BIUB placement in the VD group. In the CD groups, antibiotics were administered preoperatively once, and no additional antibiotics for BIUB placement were administered. To obtain an antibiotics administration protocol to be applied during BIUB placement, we electronically searched the PubMed and Scopus databases. Results No significant differences were observed in endometritis rates between BIUB and non-BIUB groups of all groups. In the literature review, of 27 suitable publications identified, multiple doses of antibiotics were administered in 17 (62.9%) studies and none investigated the efficacy of a protocol for antibiotic. Conclusion Our protocol might be effective and sufficient in preventing postpartum BIUB placement-related endometritis.
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Affiliation(s)
- Yoshikazu Nagase
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shinya Matsuzaki
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoko Kawanishi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Satoshi Nakagawa
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Aiko Kakigano
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tsuyoshi Takiuchi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuya Mimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takuji Tomimatsu
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masayuki Endo
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan.,Department of Children and Women's Health, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
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Dueckelmann AM, Hinkson L, Nonnenmacher A, Siedentopf JP, Schoenborn I, Weizsaecker K, Kaufner L, Henrich W, Braun T. Uterine packing with chitosan-covered gauze compared to balloon tamponade for managing postpartum hemorrhage. Eur J Obstet Gynecol Reprod Biol 2019; 240:151-155. [DOI: 10.1016/j.ejogrb.2019.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 05/31/2019] [Accepted: 06/04/2019] [Indexed: 11/28/2022]
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Habib N, Luton D, Centini G, Renuit I, Birbarah C, Ceccaldi PF. Advanced Interventional Procedures after Intrauterine Tamponade Balloon Insertion in a Tertiary Care Center. J INVEST SURG 2019; 34:373-379. [PMID: 31322016 DOI: 10.1080/08941939.2019.1637976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the rate of success and practicability of the intrauterine tamponade balloon (ITB) for managing PPH as a fertility-sparing tool. Methods: a five-year retrospective monocentric study in a tertiary care center including patients transferred for severe PPH. Results: In 231 patients, the success rate of ITB (n = 57), embolization (n = 58), and medical management (n = 114) was 84.21%, 74.13%, and 76.32%, respectively. Cesarean section during labor did not influence the risk of advanced interventional procedures (AIPs) for patients with ITB (odds ratio [OR] = 1.08) but did so in patients who were under expectant management in the intensive care (OR = 5.29). In the AIP subgroup of the ITB group, hemostasis was significantly deteriorated. Prothrombin time <50% (OR = 11.5), fibrinogen <2 g/L (OR = 6.88), and >4 red blood cells units (RBCs) transfused (OR = 17.2) were associated with a significantly higher risk of failure. Blood loss in the AIP patients in the embolization group was significantly higher. Patients requiring >4 units of RBCs were 22.9 times more likely to have an AIP (p = .0001). Conclusion: Compared with uterine embolization and medical management, ITB use in a tertiary care center was associated with lower risk of undergoing AIP, but further prospective study is required to confirm this.
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Affiliation(s)
- Nassir Habib
- Obstetrics and Gynecology Service, Beaujon Teaching Hospital, Clichy and Paris Diderot University, Clichy, France
| | - Dominique Luton
- Obstetrics and Gynecology Service, Beaujon Teaching Hospital, Clichy and Paris Diderot University, Clichy, France.,Obstetrics and Gynecology Service, Bichat Teaching Hospital, Paris and Paris Diderot University, Paris, France
| | - Gabriele Centini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Isabelle Renuit
- Anesthesiology and Reanimation Department, Beaujon Teaching Hospital and Paris Diderot University, Clichy, France
| | - Christian Birbarah
- Obstetrics and Gynecology Service, Beaujon Teaching Hospital, Clichy and Paris Diderot University, Clichy, France
| | - Pierre-François Ceccaldi
- Obstetrics and Gynecology Service, Beaujon Teaching Hospital, Clichy and Paris Diderot University, Clichy, France
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10
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Massive hemoperitoneum due to uterine perforation by the Bakri Balloon, during the treatment of postpartum hemorrhage. J Gynecol Obstet Hum Reprod 2019; 48:75-76. [DOI: 10.1016/j.jogoh.2018.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 11/15/2022]
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11
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Massive Hemorrhage From Suspected Iatrogenic Uterine Rupture. Obstet Gynecol 2018; 132:1494-1497. [PMID: 30399095 DOI: 10.1097/aog.0000000000002971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intrauterine balloon tamponade is recommended for refractory postpartum hemorrhage resulting from atony, but few studies have assessed complications associated with placement. CASE A 39-year-old woman, gravida 4 para 1, with posterior placenta previa and suspected placenta accreta had a postpartum hemorrhage after a scheduled cesarean delivery. An intrauterine balloon tamponade device was easily placed transcervically; however, the patient required additional analgesia for constant severe stabbing pain worsened on examination. Three hours after placement, the balloon was expelled from the cervix, resulting in 1,500 mL of fresh blood and clot. Emergent exploratory laparotomy identified a uterine rupture inferior and lateral to the hysterotomy site. CONCLUSION Intrauterine balloon tamponade may contribute to iatrogenic uterine rupture and should be considered in patients with refractory hemorrhage, hemodynamic instability, or severe pain despite analgesia.
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12
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Kong CW, To WWK. Intraluminal pressure of uterine balloon tamponade in the management of severe post-partum hemorrhage. J Obstet Gynaecol Res 2018; 44:914-921. [PMID: 29392798 DOI: 10.1111/jog.13596] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 12/31/2017] [Indexed: 11/30/2022]
Abstract
AIM Intrauterine balloon tamponade has been increasingly used for the management of post-partum hemorrhage (PPH) in recent years. However, data on the precise mechanisms and pressure required for the balloon tamponade are scanty in the literature. This study aims to review the intraluminal pressure (ILP) generated by the Bakri intrauterine balloon that is necessary to produce a 'positive tamponade test' during severe PPH. METHODS This was a prospective cohort study. The ILP of the Bakri balloon was measured using a manometer after a positive tamponade test was clinically achieved during severe PPH (blood loss >1 L). The patient's blood pressure was recorded, and ultrasound scan was performed to verify the position of the balloon and the presence of forward flow in the uterine arteries. The main outcome measure is the ILP of the Bakri balloon required to achieve a positive tamponade test. RESULTS Twenty patients were included for final analysis. The net ILP measured ranged from 67 to 92 mmHg, and this pressure was lower than the concurrent systolic pressure in all cases. Color Doppler confirmed positive forward flow in the uterine vessels in all cases. There were no differences in the pressure measured with the balloon position, and there was no relationship between the volumes of saline infused and the net pressure. CONCLUSION A positive tamponade test in an intrauterine balloon is probably achieved by local compression pressure exerted on the vasculature of the placental bed rather than by generating an ILP exceeding systemic blood pressure or by occlusion of flow to the uterine arteries.
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Affiliation(s)
- Choi Wah Kong
- Department of Obstetrics and Gynaecology, United Christian Hospital, Hong Kong
| | - William W K To
- Department of Obstetrics and Gynaecology, United Christian Hospital, Hong Kong
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13
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Gauchotte E, De La Torre M, Perdriolle-Galet E, Lamy C, Gauchotte G, Morel O. Impact of uterine balloon tamponade on the use of invasive procedures in severe postpartum hemorrhage. Acta Obstet Gynecol Scand 2017; 96:877-882. [DOI: 10.1111/aogs.13130] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 03/02/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Emilie Gauchotte
- Gynecology and Obstetrics Department; Maternity; Regional University Hospital (CHRU); Nancy France
| | - Manuela De La Torre
- Gynecology and Obstetrics Department; Maternity; Regional University Hospital (CHRU); Nancy France
- University of Lorraine; Vandœuvre-lès-Nancy France
| | - Estelle Perdriolle-Galet
- Gynecology and Obstetrics Department; Maternity; Regional University Hospital (CHRU); Nancy France
| | - Catherine Lamy
- Gynecology and Obstetrics Department; Maternity; Regional University Hospital (CHRU); Nancy France
| | | | - Olivier Morel
- Gynecology and Obstetrics Department; Maternity; Regional University Hospital (CHRU); Nancy France
- University of Lorraine; Vandœuvre-lès-Nancy France
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14
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Kaya B. Reply to: Bakri balloon vs. B-Lynch suture as hemostatic procedures for atonic bleeding: clarifications and concerns. Arch Gynecol Obstet 2016; 293:1149-51. [PMID: 26993516 DOI: 10.1007/s00404-016-4064-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 02/16/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Baris Kaya
- Department of Obstetrics and Gynecology, Near East University Faculty of Medicine, Lefkosa-TRNC, Mersin 10, Turkey.
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Which uterine sparing technique should be used for uterine atony during cesarean section? The Bakri balloon or the B-Lynch suture? Arch Gynecol Obstet 2016; 294:511-7. [DOI: 10.1007/s00404-016-4015-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 01/05/2016] [Indexed: 10/22/2022]
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16
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Abstract
Bakri balloons are minimally invasive devices placed in the uterus and inflated with saline to apply extrinsic pressure to stop postpartum hemorrhage. Sonography is an ideal imaging modality to confirm position of a Bakri balloon because it is quick and precise in locating the device, does not use ionizing radiation, and is inexpensive. This case report describes the sonographic documentation and management of a malpositioned Bakri balloon.
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17
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Marasinghe JP, Du Plessis J, Epitawela D, Umstad MP. Management of postpartum haemorrhage with uterine balloon tamponade: The way forward. Aust N Z J Obstet Gynaecol 2015; 55:315-7. [PMID: 26130087 DOI: 10.1111/ajo.12333] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 02/19/2015] [Indexed: 11/26/2022]
Abstract
Uterine balloon tamponade has rapidly gained popularity in the management of postpartum haemorrhage. It is a conservative method often utilised before embarking on advanced surgical interventions. The mechanism of action, complications and long-term outcomes are discussed.
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Affiliation(s)
| | | | | | - Mark P Umstad
- Royal Women's Hospital, Parkville, Victoria, Australia
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18
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Miller DT, Roque DM, Santin AD. Use of Monsel solution to treat obstetrical hemorrhage: a review and comparison to other topical hemostatic agents. Am J Obstet Gynecol 2015; 212:725-35. [PMID: 25577672 PMCID: PMC4457701 DOI: 10.1016/j.ajog.2014.12.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
Abstract
Peripartum hemorrhage accounts for 8% of maternal deaths in the United States, and nearly 27% worldwide. A growing need exists for tactics to spare morbidity given a rise of abnormal placentation that contributes to excessive blood loss at the time of delivery. Approaches such as compression sutures, balloon tamponade, and pelvic artery embolization are not without side effects and potential implications for future fertility. The use of topical hemostatic agents has become widespread in gynecologic and obstetric surgery despite a paucity of distinct studies in the field, and may allow providers to increasingly avoid cesarean hysterectomy. A variety of topical hemostatic agents exist along a wide cost continuum, each characterized by specific efficacy, advantages, drawbacks, and often gaps in long-term data to support safety and impact on future fertility. Herein, we comprehensively review these agents and illustrate a nontraditional use of Monsel solution applied directly to the placental bed in a case of focal placenta accreta. This ultimately contributed to successful uterine preservation with no known adverse sequelae. Monsel solution may have a role in establishing hemostasis in the setting of abnormal placentation, and may be a particularly attractive alternative in resource-poor nations.
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Affiliation(s)
- Devin T Miller
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Dana M Roque
- University of Maryland School of Medicine, Baltimore, MD
| | - Alessandro D Santin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT.
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Morel O, Perdriolle-Galet E, Mézan de Malartic C, Gauchotte E, Moncollin M, Patte C, Chabot-Lecoanet AC. Prise en charge obstétricale en cas d’hémorragie du post-partum qui persiste malgré les mesures initiales ou qui est sévère d’emblée, après accouchement par voie basse. ACTA ACUST UNITED AC 2014; 43:1019-29. [DOI: 10.1016/j.jgyn.2014.09.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Akladios C, Sananes N, Gaudineau A, Boudier E, Langer B. Hémorragie secondaire du post-partum. ACTA ACUST UNITED AC 2014; 43:1161-9. [DOI: 10.1016/j.jgyn.2014.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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21
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Thubert T, Demoulin G, Benachi A, Deffieux X. [Be careful with intrauterine balloon placement in the management of secondary post partum hemorrhage]. ACTA ACUST UNITED AC 2014; 44:97-8. [PMID: 25015327 DOI: 10.1016/j.jgyn.2014.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 06/12/2014] [Accepted: 06/13/2014] [Indexed: 10/25/2022]
Affiliation(s)
- T Thubert
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, AP-HP, 92141 Clamart, France.
| | - G Demoulin
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, AP-HP, 92141 Clamart, France
| | - A Benachi
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, AP-HP, 92141 Clamart, France
| | - X Deffieux
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, AP-HP, 92141 Clamart, France
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