Effect of routine rapid insertion of Bakri balloon tamponade
on reducing hemorrhage from placenta previa
during and after cesarean section
Received: 22 March 2017 / Accepted: 22 June 2017 / Published online: 24 June 2017
Ó Springer-Verlag GmbH Germany 2017
Purpose To evaluate the effectiveness of routine rapid
insertion of a Bakri balloon during cesarean section for
placenta previa based on a retrospective control study.
Methods Women with singleton pregnancies who under-
went cesarean section for placenta previa at our institution
between 2003 and 2016 were enrolled. Between 2015 and
2016, women who routinely underwent balloon tamponade
during cesarean section were deﬁned as the balloon group.
Between 2003 and 2014, women who underwent no
hemostatic procedures except balloon tamponade were
deﬁned as the non-balloon group. The clinical outcomes of
the two groups were retrospectively analyzed.
Results Of the 266 women with placenta previa, 50 were in
the balloon group and 216 were in the non-balloon group.
The bleeding amounts were signiﬁcantly smaller in the
balloon group than in the non-balloon group: intraoperative
bleeding (991 vs. 1250 g, p \ 0.01), postoperative bleed-
ing (62 vs. 150 g, p \ 0.01), and total bleeding (1066 vs.
1451 g, p \ 0.01). Furthermore, the mean surgical duration
was shorter in the balloon group than the non-balloon
group (30 vs. 50 min, p \ 0.01). In the balloon group, ﬁve
patients suffered from increasing hemorrhage due to pro-
lapse of the balloon from the uterus after the operation, but
the hemorrhage was controlled by balloon re-insertion
without additional hemostatic procedures.
Conclusions This study demonstrated that the routine rapid
insertion of Bakri balloon tamponade during cesarean
section signiﬁcantly decreased intra- and postoperative
hemorrhage and shortened the surgical duration in women
with placenta previa.
Keywords Bakri balloon Á Cesarean section Á Placenta
previa Á Hemorrhage
The prevalence of placenta previa is approximately 4.8 of
every 1000 pregnancies .
Placenta previa is a well-known cause of massive peri-
natal hemorrhage that induces high maternal and neonatal
mortality and morbidity [2, 3]. Therefore, several methods
to control uterine hemorrhage have been reported: gauze
packing, uterine brace sutures, arterial ligation, uterine
artery embolization, and hysterectomy [4–8]. These pro-
cedures have their respective advantages and disadvantages
[9–11]. For example, gauze tamponade is inexpensive, but
has uncertain outcomes and a high risk of infection.
Uterine compression sutures, arterial ligation, uterine
artery embolization, and hysterectomy are reportedly reli-
able, but more invasive and require specialized surgical
The effectiveness of Bakri balloon tamponade (BBT)—
a new tool to control postpartum hemorrhage with a high
success rate—has been reported [10, 12–16]. Furthermore,
a management plan for the treatment of postpartum hem-
orrhage using BBT has been established . The timing
of massive hemorrhage in placenta previa was not only
postpartum, but also intraoperative duration, particularly
just after the removal of the placenta . Therefore, it is
essential for decreasing both postpartum and intraoperative
hemorrhage to ensure complete control of the hemorrhage
& Hiroaki Soyama
Department of Obstetrics and Gynecology, National Defense
Medical College, 3-2 Namiki, Tokorozawa,
Saitama 359-8513, Japan
Arch Gynecol Obstet (2017) 296:469–474