Impact of Embolization and Bakri Balloon Tamponade on Rate of Surgical Intervention for Postpartum Uterine Atony [5R]

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INTRODUCTION:Our objective was to evaluate the impact of uterine artery embolization (UAE) and Bakri balloon tamponade on the rate of surgical treatments, including B-Lynch procedure and hysterectomy due to postpartum uterine atony.METHODS:We performed a retrospective cohort study of all deliveries greater than 20 weeks gestation from January 2002 until March 2013 at Baystate Medical Center. Charts were reviewed to determine incidence of postpartum hysterectomy, Bakri balloon placement, UAE, and B-Lynch procedure. Patients with evidence of placenta accreta were excluded. The rates of surgical treatment (hysterectomy or B-Lynch procedure) for postpartum hemorrhage were compared between the periods before and after increased utilization of non-surgical methods (UAE and Bakri balloon tamponade) using chi-square testing.RESULTS:A total of 21 hysterectomies were performed for postpartum hemorrhage secondary to uterine atony during the study period. 14 were performed before and 7 after the introduction of Bakri balloon. The rate of postpartum hysterectomy decreased with a rate of 7.8/10,000 deliveries before and 2.2/10,000 deliveries after availability of the Bakri (P=.01). There was also a decrease in use of B-Lynch procedure with a rate of 5.57/10,000 deliveries before and 1.62/10,000 deliveries after the Bakri was available (P=.03). There were 43 Bakri balloon placements during the study period of which only 1 required hysterectomy and 8 underwent UAE. UAE utilization also increased after introduction of the Bakri balloon.CONCLUSION:Our findings show that utilization of non-surgical methods, including UAE and Bakri balloon tamponade, is associated with decreased rate of surgical interventions.

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