Factors Associated with Failure of Bakri Balloon Tamponade for the Management of Postpartum Haemorrhage. Case Series Study and Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Case Series of BBT for PPH
2.2. Systematic Review
2.3. Eligibility Criteria and Outcome Measures
2.4. Information Sources and Search Strategies
2.5. Study Selection, Data Extraction, Statistical Analysis, and Risk of Bias
3. Results
3.1. Case Series of BBT for PPH
3.2. Systematic Review
4. Discussion
4.1. Main Findings
4.1.1. Case Series of BBT for PPH
4.1.2. Systematic Review
4.1.3. Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | Total (n = 123) | BBT Success Group (n = 100) | BBT Failure Group (n = 23) | p Value |
---|---|---|---|---|
Maternal and perinatal characteristics | ||||
Maternal age (years) | 33.7 ± 5.7 (21–45) | 34.3 ± 5.3 (21–45) | 31.1 ± 6.7 (21–43) | 0.043 |
Primiparous | 81 (65.9%) | 63 (63%) | 18 (78.3%) | 0.164 |
History of caesarean section | 15 (12.2%) | 11 (11%) | 4 (17.4%) | 0.398 |
Twin pregnancy | 27 (22%) | 24 (24%) | 3 (13%) | 0.252 |
Gestational age at delivery (weeks) | 37.4 ± 3.3 (24–42) | 37.3 ± 3.4 (24–41) | 37.7 ± 2.6 (31–42) | 0.898 |
hematocrit on admission (%) | 35.2 ± 4.1 (22.1–43.9) | 35.6 ± 4.2 (22.1–43.9) | 33.9 ± 2.9 (26.9–37.5) | 0.019 |
Induction of labour | 58 (47.2%) | 50 (50%) | 8 (34.8%) | 0.187 |
Caesarean delivery | 52 (42.3%) | 36 (36%) | 16 (69.6%) | 0.003 |
Neonatal birth weight (g) | 2883.2 ± 758.4 (600–4320) | 2851.2 ± 794.5 (600–4320) | 3022.2 ± 569.7 (1820–4020) | 0.431 |
PPH characteristics and maternal haemodynamic state data | ||||
Primary PPH | 115 (93.5%) | 93 (93%) | 22 (95.7%) | 0.642 |
Aetiology of PPH | ||||
Uterine atony | 86 (69.9%) | 73 (73%) | 13 (56.5%) | |
Retention of placental fragments | 14 (11.4%) | 14 (14%) | 0 | |
Placenta previa | 6 (4.9%) | 1 (1%) | 5 (21.7%) | |
Placenta accreta | 8 (6.5%) | 5 (5%) | 3 (13%) | |
Vaginal/cervical tears | 3 (2.4%) | 2 (2%) | 1 (4.3%) | |
DIC | 2 (1.6%) | 1 (1%) | 1 (4.3%) | 0.001 |
Curettage before BBT insertion | 80 (65%) | 71 (71%) | 9 (39.1%) | 0.004 |
Estimated blood loss before BBT | ||||
1000 mL | 23 (18.7%) | 21 (21%) | 2 (8.7%) | |
1000–2500 mL | 87 (70.7%) | 75 (75%) | 12 (52.2%) | |
2500–5000 ml | 13 (10.6%) | 4 (4%) | 9 (39.9%) | 0.001 |
First post-bleed hematocrit (%) | 25.6 ± 5.2 (11.8–38.7) | 25.6 ± 5.3 (14–38.7) | 25.2 ± 4.6 (11.8–31.6) | 0.984 |
Need for transfusion | 85 (69.1%) | 64 (64%) | 21 (91.3%) | 0.011 |
RBCUs per patient | 5.2 ± 5.4 (0–40) | 3.4 ± 2.1 (0–11) | 11.1 ± 7.9 (1–40) | 0.001 |
≥7 RBCUs transfused | 21 (17.1%) | 5 (5%) | 16 (69.6%) | 0.001 |
FFPUs per patient | 3.7 ± 4.9 (0–30) | 1.9 ± 1.4 (0–4) | 5.8 ± 6.4 (0–30) | 0.001 |
Number of concentrated platelets transfused per patient | 1.7 ± 2.6 (0–14) | 0.6 ± 0.6 (0–2) | 2.6 ± 3.4 (0–14) | 0.002 |
Fibrinógeno (gr) per patient | 2.9 ± 2.7 (0–20) | 2.1 ± 0.9 (0–6) | 4.8 ± 4.4 (1–20) | 0.001 |
Admission to PARU | 101 (82.1%) | 98 (98%) | 3 (13%) | 0.001 |
Admission to ICU | 21 (17.1%) | 2 (2%) | 19 (82.6%) | 0.001 |
Hospital stay (days) | 5.2 ± 5.3 (1–49) | 4.4 ± 3.3 (2–25) | 9.1 ± 9.3 (1–49) | 0.001 |
BBT main parameters | ||||
Vaginal BBT placement | 117 (95.1%) | 97 (97%) | 20 (87%) | 0.044 |
Filling volumen (mL) | 255.6 ± 100.7 (60–540) | 250.3 ± 92 (90–500) | 286.5 ± 141.3 (60–540) | 0.435 |
Balloon output (mL) | 173.4 ± 264.5 (0–1800) | 109.5 ± 89.9 (0–700) | 573.1 ± 534.3 (25–1800) | 0.001 |
Duration of placement (hours) | 18.7 ± 8.1 (0–36) | 20.4 ± 5.8 (2–36) | 11.5 ± 12.1 (0–36) | 0.003 |
Variables Significantly Associated with Failed BBT | OR | 95% CI | p Value |
---|---|---|---|
Maternal age | 1.26 | 1.07–1.47 | 0.01 |
Caesarean delivery | 6.90 | 1.23–38.65 | 0.03 |
Curettage before BBT insertion | 9.02 | 1.69–48.22 | 0.01 |
≥7 RBCUs transfused | 68.39 | 12.60–371.33 | <0.001 |
Report (Author and Year) | Country | Type of Study | n | Vaginal/Caesarean Delivery n (%) | Indications for BBT n (%) | Clinical Success n (%) | Hysterectomy n (%) | Death n (%) | BBT-Related Complications |
---|---|---|---|---|---|---|---|---|---|
Revert M et al. 2016 [20] | France | Prospective cohort study; 10 maternity units | 226 | 171 (75.5%)/55 (24.3%) | Uterine atony: 183 (81%); Placenta previa: 33 (14.6%); Others: 10 (4.4%) | 188 (83.2%) | 11 (4.9%) | 0 | 1 endometritis |
Maher MA et al. 2017 [21] | Saudi Arabia | Prospective cohort study; 2 hospitals | 72 | Cesarean: 72 (100%) | Placenta low-lying: 42 (58.5%); Placenta incomplete centralis: 20 (27.7%); Placenta complete centralis: 10 (13.8%) | 63 (87.5%) | 1 (1.4%) | 0 | 0 |
Kong CW et al. 2018 [23] | Hong Kong | Retrospective | 81 | 24 (29.6%)/57 (70.4%) | Uterine atony: 53 (65.4%); Placenta previa/accreta: 25 (30.9%); Uterine/vaginal/cervical tears: 3 (3.7%) | 59 (72.8%) | 11 (13.6%) | 1 (1.2%) | 0 |
Cho HY et al. 2015 [22] | Korea | Retrospective | 64 | Cesarean: 64 (100%) | Placenta previa totalis: 50 (78%); Placenta previa partialis. marginalis: 11 (17%); Low-lying placenta: 3 (5%) | 48 (75%) | 5 (8%) | 0 | 0 |
Grange J et al. 2018 [24] | France | Retrospective case series study; 5 maternity units | 108 | Vaginal: 108 (100%) | Uterine atony: 39 (36.1%); Placenta previa: 6 (5.5%); Placenta accreta: 3 (2.8%); Retained placenta: 23 (21.3%) | 80 (74.1%) | 5 (4.6%) | 0 | 2 thromboembolic events |
Total | 551 | 303 (55%)/248 (45%) | Uterine atony: 275 (50%); Placenta previa: 155 (28.1%) | 438 (79.5%) | 33 (6%) | 1 (0.2%) |
Report (Author and Year) | Variables Significantly Associated with Failed BBT | OR | 95% CI | p Value |
Revert M et al. 2016 [20] | Caesarean delivery | 3.5 | 1.6–7.6 | <0.05 |
Estimated blood loss before BBT | 3.2 | 1.5–6.8 | <0.05 | |
Coagulopathy | 5.6 | 2.5–13.0 | <0.05 | |
Cho HY et al. 2015 [22] | Anterior placenta | 12.75 | 1.04–155.94 | 0.04 |
History of cesarean section | 8.9 | 2.27–34.83 | <0.01 | |
Grange J et al. 2018 [24] | Pre-pregnancy obesity | 4.4 | 1.06–18.31 | <0.05 |
Report (Author and Year) | Variables Significantly Associated with Successful BBT | OR | 95% CI | p Value |
Maher MA et al. 2017 [21] | Placenta accreta | 0.01 | 0.00–0.97 | 0.049 |
Operation duration (min) | 1.14 | 1.02–1.28 | 0.023 | |
Kong CW et al. 2018 [23] | Blood loss at the time of insertion of BBT | 0.99 | 0.99–0.99 | 0.041 |
Volume of blood drained from the uterine cavity within first 30 min | 0.97 | 0.95–0.99 | 0.034 | |
Placenta accreta | 0.01 | 0.01–0.98 | 0.048 | |
Coagulopathy | 0.02 | 0.01–0.96 | 0.048 |
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Ruiz Labarta, F.J.; Pintado Recarte, M.P.; Joigneau Prieto, L.; Bravo Arribas, C.; Bujan, J.; Ortega, M.A.; De León-Luis, J.A. Factors Associated with Failure of Bakri Balloon Tamponade for the Management of Postpartum Haemorrhage. Case Series Study and Systematic Review. Healthcare 2021, 9, 295. https://doi.org/10.3390/healthcare9030295
Ruiz Labarta FJ, Pintado Recarte MP, Joigneau Prieto L, Bravo Arribas C, Bujan J, Ortega MA, De León-Luis JA. Factors Associated with Failure of Bakri Balloon Tamponade for the Management of Postpartum Haemorrhage. Case Series Study and Systematic Review. Healthcare. 2021; 9(3):295. https://doi.org/10.3390/healthcare9030295
Chicago/Turabian StyleRuiz Labarta, Francisco Javier, María Pilar Pintado Recarte, Laura Joigneau Prieto, Coral Bravo Arribas, Julia Bujan, Miguel A. Ortega, and Juan A. De León-Luis. 2021. "Factors Associated with Failure of Bakri Balloon Tamponade for the Management of Postpartum Haemorrhage. Case Series Study and Systematic Review" Healthcare 9, no. 3: 295. https://doi.org/10.3390/healthcare9030295