Luigi Frigerio

297 -  Bakri balloon tamponade and uterine packing with gauze in post partum hemorrhage management: any differences?
Luisa Patanè, Giorgia Cavalli, Valentina Mandelli, Nicola Strobelt, Luigi Frigerio, Serena Pirola, Maria Giovanna Piccoli
American Journal of Obstetrics & Gynecology (Vol.210, Issue 1)
OBJECTIVE:  To  compare  the  safety  and  ef fi cacy  of  Bakri  balloon tamponade (BBT) and uterine gauze packing (UGP) in case of severe post partum hemorrhage (PPH) refractory to medical therapy.
STUDY  DESIGN:  We  retrospectively  reviewed  and  analyzed  all  the datacharts of severe PPH (blood loss > 1000 mL) occurred between January 2011 and May 2013 in our institution, in which BBT or UPG were used as second line therapy after failure of medical treatment.
Multiple gestations were excluded from the analysis.
Procedure was considered successfull when no additional therapies  for  hemorrhage  control  were  needed.  In  case  of  procedure failure  the  successive  treatments  included  radiologically  guided uterine  artery  embolization  (UAE)  and/or  surgical  procedures (uterine compression sutures, artery ligation and hysterectomy). We compared BBT and UGP in term of safety and ef fi cacy in controlling severe PPH.
P < 0.05 was considered statistically signi fi cant.
RESULTS:  In  the  study  period  61  uterine  tamponades  were  performed: 32 with Bakri balloon (group A) and 29 with uterine gauze (group  B).  The  two  groups  were  similar  according  to  maternal characteristics,  delivery  mode,  mean  blood  loss,  need  for  transfusions, rate of endometritis and days of recovery. BBT alone was successfull in 26/32 cases (81%), in 6 cases (19%) additional UAE was required. No hysterectomies were performed in the Bakri group. UGP alone was effective in 20/29 cases (68%), 8 patients needed an UAE and 2 cases required an hysterectomy. The effectiveness of the two methods was comparable (26/32 vs 20/29; p< 0.2).
CONCLUSION: BBT and UPG are both safe and effective methods to control severe PPH after failure of traditional medical therapy.