A positive “tamponade test”—observable marked reduction in bleeding through the outlet port after placement of the balloon—suggests that the intervention will be successful. Continued bleeding through the port after placement of the balloon suggests that additional interventions, such as hysterectomy or PTE, may be necessary. The Bakri balloon is inexpensive and can be used without the resources necessary to perform a laparotomy or interventional angiography.
Combined approaches
Some physicians combine low- and high-technology approaches. For example, in a recent case of massive postpartum hemorrhage in the middle of the night, an attending placed an SOS Bakri tamponade balloon to stabilize the patient. The next morning, when the interventional radiology team had assembled, the patient had the balloon removed and underwent PTE of the uterine arteries.
What is your strategy?
It is gratifying to see parallel development of effective low- and high-technology approaches to management of massive postpartum hemorrhage. What technical interventions have you found most effective for the treatment of massive postpartum hemorrhage? Should all obstetric services have access to the high-technology interventional radiology procedures? Please share your thoughts with us.