Postpartum hemorrhage (PPH) is a life-threatening complication of delivery. It can occur after vaginal or cesarean delivery and is a major cause of maternal morbidity and mortality in both developing and developed countries as well.
The most common cause of PPH is uterine atony; up to 80% of the cases result from suboptimal contraction of the myometrium following placental separation.
After excluding other etiologies of PPH such as retained placenta, uterine rupture, genital tract trauma, uterine inversion, and coagulopathy, the management of uterine atony should be timely and initiated to prevent hemorrhagic, hypovolemic shock, dilutional coagulopathy, tissue hypoxia, and acidosis. The pituitary gland, the kidneys, and the lungs are particularly susceptible organs to damage when perfusion pressure decreases resulting in feared sequelae of postpartum hypovolemic shock such as Sheehan syndrome (ie, postpartum hypopituitarism), renal failure, and acute respiratory distress syndrome.
The repertoires of the management measures can be generally divided into operative and nonoperative interventions. In acute postpartum hemorrhage refractory to medical and other conservative interventions, invasive therapies may include arterial embolization, uterine compression sutures, uterine artery ligation, and, ultimately, hysterectomy. However, these measures are highly invasive, require extensive resources, expertise, and are associated with significant morbidities.
Intrauterine balloon tamponade has been suggested as an effective, easily administered minimally invasive treatment option to control uterine bleeding while preserving the mother’s ability to bear additional children.
Multiple types of balloons are available, including Bakri balloon, BT-cath balloon tamponade catheter, Foley catheters, Rusch balloon, condom catheters and the Sengstaken-Blakemore tube. The Bakri postpartum balloon
and the BT-cath balloon tamponade catheter
are specifically designed for postpartum intrauterine tamponade, and they are the only such devices approved by the US Food and Drug Administration for this application.
However, in settings where these are unavailable, other balloons can be used to achieve a similar effect.
In term of mechanism of action, the intrauterine balloon is believed to act by exerting inward to outward pressure against the uterine wall, resulting in a reduction in persistent capillary and venous bleeding from the endometrium and the myometrium.
In 2006, the ACOG Practice Bulletin, published by the American College of Obstetricians and Gynecologists, made mention of the Bakri postpartum balloon for its specifically tailored design that enables conservative management of uterine bleeding in cases of uterine atony and other causes of PPH.
Global awareness and use of the Bakri postpartum device has grown steadily since 2006 as physicians, hospitals, and other medical institutions have sought effective, minimally invasive means to control uterine bleeding.