Department of Obstetrics and Gynecology, Bursa Yüksek Ihtisas Training and Research Hospital, Bursa, Turkey.
J Coll Physicians Surg Pak. 2020 Jul;30(7):707-712. doi: 10.29271/jcpsp.2020.07.707.
To investigate the effectiveness and success rate of Bakri balloon tamponade (BBT) for postpartum haemorrhage (PPH) in patients with placenta previa and placenta accreta spectrum (PAS).
Descriptive study.
Department of Obstetrics and Gynaecology, Bursa Yüksek Ihtisas Education and Research Hospital, Bursa, Turkey, from June 2016 to June 2019.
Patients treated with BBT for severe PPH and uncontrollable bleeding due to treatment failure with uterotonic agents were retrospectively analysed. Exclusion criteria were age <18 years and >46 years, having multiple pregnancies, less amount of bleeding than indicated in the definition of PPH and requiring no BBT and those with hemodynamic instability before BBT requiring emergency postpartum hysterectomy, and having missing obstetric and laboratory data. The main outcome was the rate of surgical exploration and peripartum hysterectomy following the use of BBT as an adjunct treatment for refractory PPH. Secondary outcome was the need for blood transfusion. The BBT was considered to fail, if the bleeding from drainage catheter was continued and more than 100 mL during failure was 10 minutes. In case of BBT failure, C-section hysterectomy was performed.
Of the 128 patients, 14 (10.9%) had vaginal birth and 109 (85.2%) had Cesarean section delivery. Of patients with cesarean section delivery, 84 (65.6%) had multiple repeat cesarean deliveries and 22 (17.2%) were previous cesarean cases. Ninety-one patients (71.1%) had placental site abnormality. Twenty patients (15.6%) underwent hypogastric and uterine artery ligation. Eleven patients (8.7%) with persistent uterine bleeding and hemodynamic instability underwent hysterectomy. Success rate of BBT was found to be 91.3% in PPH. No mortality was observed.
BBT is an effective tool for management of postpartum uterine atony and prevention of persistent PPH in patients with placenta previa and placenta accreta spectrum due to increased cesarean section and uterine surgeries in recent years. Key Words: Placenta previa, Placenta accreta spectrum, Postpartum haemorrhage, Balloon tamponade, Bakri balloon.
探讨 Bakri 球囊填塞（BBT）在前置胎盘和胎盘植入谱系（PAS）患者产后出血（PPH）中的有效性和成功率。
描述性研究。
土耳其布尔萨 Yüksek Ihtisas 教育和研究医院妇产科，2016 年 6 月至 2019 年 6 月。
回顾性分析因宫缩剂治疗失败导致严重 PPH 和无法控制的出血而接受 BBT 治疗的患者。排除标准为年龄<18 岁和>46 岁、多胎妊娠、出血量少于 PPH 定义的出血量、无需 BBT 且 BBT 前血流动力学不稳定需要紧急产后子宫切除术、以及缺失产科和实验室数据。主要结局是 BBT 作为难治性 PPH 辅助治疗后的手术探查和围产期子宫切除术率。次要结局是输血需求。如果引流导管的出血持续存在，并且失败后 10 分钟内出血量超过 100 mL，则认为 BBT 失败。如果 BBT 失败，行剖宫产子宫切除术。
在 128 名患者中，14 名（10.9%）行阴道分娩，109 名（85.2%）行剖宫产。在剖宫产分娩的患者中，84 名（65.6%）有多次重复剖宫产，22 名（17.2%）为既往剖宫产。91 名患者（71.1%）有胎盘部位异常。20 名患者（15.6%）行下腹动脉和子宫动脉结扎术。11 名（8.7%）持续子宫出血和血流动力学不稳定的患者行子宫切除术。PPH 中 BBT 的成功率为 91.3%。未观察到死亡。
由于近年来剖宫产和子宫手术的增加，BBT 是治疗前置胎盘和胎盘植入谱系患者产后子宫收缩乏力和预防持续 PPH 的有效工具。
前置胎盘；胎盘植入谱系；产后出血；球囊填塞；Bakri 球囊。
