Dr. M Movahedi MD

Balloon tamponade is an effective adjunct in the treatment of severe postpartum hemorrhage secondary to uterine atony, especially when medical therapy fails. The catheter provides temporary reduction of postpartum uterine bleeding if management with mterotonics, repair of genital lacerations, and removal of retained placental tissue has been unsuccessful.

SOS Bakri Tamponade Balloon Catheter 24- French , 54 – cm long Contains a large central lumen and a 5oocc balloon. 100% silicon ( no latex ) Ductile shape allows it to conform to uterine anatomy and shape it allows for hemostatic cushion application , and limits clot adhesion . the large diameter lumen in the shaft and multi – ported, non – abrasive tip allows for constant drainage, so an ongoing uterine hemorrhage dose not go undetected post – application. Once deflated the Bakri Balloon is easily removed trans – vaginally without the need for an additional surgical procedure. Approved by the FDA for spec

I Introduction -Easily administered and removed. The ideal choice for managing a patient's postpartum hemorrhage: -Easily administered and removed. - Control of capillary / venous bleeding and surface oozing - Ability to gauge success of treatment in real time . -Avoid hysterectomy to preserve the patient's reproductive potential.

Bakri Balloon is placed at the time of cesarean delivery , or After vaginal delirery 1- How in cesarean delivery ? An assistant working from below helps pull the distal end of the balloon shaft through the cervix into the vagina The hysterectomy incision is closed . A vaginal pack is placed to keep the balloon seated in the uterus. The balloon is filled with 250 – 500cc of sterile isotonic fluid. The distal end of the balloon is attached to a weight.

2-How after vaginal delivery A foley catheter is inserted in the bladder The uterus is examined to ensure that there are no retained placenta. The balloon is inserted so that the entire balloon past the internal os. Using a syringe , the balloon is filled with sterile saline ( 250 – 500 ml) Gentle downward traction Vaginal packing may be useful to help keep the balloon The drainage port of the balloon is connected to a fluid collection. The balloon is kept inflated for 12- 24 h .

Comparison Sengstaken – Blakemore balloon This is a naso – gastric balloon for tamponade of esophageal varicoceles and the introduction of contrast media Dose not necessarily take uttering shape Expensive Contains latex Not indicated for management of PPH

Foley catheters Comparison Inexpensive , but are generally ineffective in a large , postpartum uterine cavity. The application of multiple foleys is cumbersome and less effective than the Bakri Balloon if applied individually without an overbag , foleys do not readily conform to uterine anatomy Foley's applied jointiy in a plastic covering or overbag , do not allow for proper drainage , and can conceal uterine hemorrhage

Comparison Bakri Balloon Bakri balloon comes packaged with syring , and stores like other surgical tools May be applied quickiy and easily Open inner lumen allows for direct measurement of ongoing blood loss. Silastic balloon conforms to uterine cavity decreasing chance of uttering trauma Can be removed quickly without additionl invasive procedure.

Comparison Uterine packing Nominal material cost Possible concealed hemorrhage No record of blood loss Potential uterine trauma during application Removal post – treatement can require an additional trip to OR