Bakri balloon
The Bakri balloon is a medical device invented and designed by Dr. Younes Bakri in 1999.[1]
The obstetrical balloon is a 24 French, 54 cm-long, silicone catheter with a filling capacity of 500 mL. The device is used for the temporary control and reduction of postpartum hemorrhage (PPH).
According to the World Health Organization, around 100,000 maternal deaths occur every year from PPH and is the leading cause of maternal mortality in the developed world.[2]
Use
[edit]The Bakri balloon is a silicone, obstetrical balloon specifically designed to treat postpartum hemorrhage (PPH). The device is used for the "temporary control or reduction of postpartum hemorrhage when conservative management of uterine bleeding is warranted."[1]
Novel uses of the Bakri Balloon have been reported in the treatment of Empty Pelvis Syndrome (EPS), Gestational Trophoblastic Neoplasia (GTN) and uterine atony.
Collaborative research published in the British Journal of Surgery identified the Bakri Balloon as one of the devices used in mitigation strategies for EPS [3]
Soheila Aminimoghaddam et al. described an efficient method in preventing EPS by placing the Bakri Balloon in the pelvic cavity after exenteration. The results showed the balloon was a useful tool in providing "a physical barrier to prevent the descending of intestinal loops and a breeding ground for reconstruction of the pelvic floor".[4]
Between December 2019 and May 2022, Mufaddal Kazi et al. used the Bakri Balloon on 75 patients in a study to determine its efficacy in preventing EPS. They reported no complications. Although a larger comparative study was needed, deploying the Bakri Balloon was considered a safe method following pelvic exenteration.[5]
The Bakri Balloon was also seen as a "simple, safe and cost-effective method" to reduce EPS complications by S Bankar et al. when combined with other surgical techniques.[6]
The Bakri Balloon as a life saving technique to treat Gestational Trophoblastic Neoplasia (GTN) lesions was described by BG Goldman et al. after other attempts at managing GTN led to catastrophic bleeding and patient instability. Their recommendations included the balloon as a primary method for treatment.[7]
Zurich University Hospital used a modified Bakri balloon to treat 66 patients with uterine atony from March 2017 until June 2020. Christian Haslinger et al. connected the balloon to a vacuum device and applied 60–70 kPa vacuum. Their findings showed a success rate of 86%.[8]
Cases
[edit]One study in Finland[9] involving 50 patients recorded an overall success rate of 86% when using the Bakri balloon in managing PPH. A German study involving 20 patients cited an overall success rate of 90% when the balloon is used in combination with B-Lynch sutures.[10]
In 2023, a 4-year case study (2016–2020) in China involving 279 women was published and concluded that the Bakri balloon was an effective treatment in controlling postpartum hemorrhage. The overall success rate was 88.89% and supported those from previous studies. [11]
Endorsements
[edit]Both the International Federation of Gynaecology and Obstetrics (FIGO) and the International Confederation of Midwives (ICM) have approved the balloon as one of the primary support tools in treating PPH.[12]
In 2021, the World Health Organization recommended the Bakri Balloon as part of its guidelines to help reduce the maternal mortality ratio to less than 70 per 100,000 live births by 2030.[13]
See also
[edit]References
[edit]- ^ a b "Bakri® Postpartum Balloon with Rapid Instillation Components". Cook Medical Products.
- ^ Abouzahr, C (1998). "Antepartum and postpartum haemorrhage". In Murray, Christopher J. L.; Lopez, Alan D. (eds.). Health Dimensions of Sex and Reproduction: The Global Burden of Sexually Transmitted Diseases, HIV, Maternal Conditions, Perinatal Disorders, and Congenital Anomalies. Harvard School of Public Health. pp. 172–174. ISBN 978-0-674-38335-7.
- ^ PelvEx Collaborative, The empty pelvis syndrome: a core data set from the PelvEx collaborative, British Journal of Surgery, Volume 111, Issue 3, March 2024, znae042, https://doi.org/10.1093/bjs/znae042
- ^ Aminimoghaddam S, Hivehchi N, Ghaemi M, Eshghinejad A, Yazdizadeh M. Using Bakri balloon as a visceral replacement for occupying pelvic cavity in pelvic exenteration, a case report. Int J Surg Case Rep. 2022 Oct;99:107646. doi: 10.1016/j.ijscr.2022.107646. Epub 2022 Sep 13. PMID 36261941; PMCID: PMC9568762.
- ^ Kazi M, Desouza A, Bankar S, Jajoo B, Dohale S, Vadodaria D, Ghadi A, Ghandade N, Vasudevan L, Nashikkar C, Saklani A. The use of an obstetric balloon as a pelvic spacer in preventing empty pelvis syndrome after total pelvic exenteration in rectal cancers - A prospective safety and efficacy study for the Bakri balloon. Colorectal Dis. 2023 Apr;25(4):616-623. doi: 10.1111/codi.16424. Epub 2022 Nov 28. PMID 36408669.
- ^ Bankar S, Desouza A, Paliwal V, Pandey D, Gori J, Sukumar V, Rohila J, Saklani A. Novel use of the Bakri balloon to minimize empty pelvis syndrome following laparoscopic total pelvic exenteration. Colorectal Dis. 2020 Dec;22(12):2322-2325. doi: 10.1111/codi.15319. Epub 2020 Sep 4. PMID 32810348.
- ^ Goldman, Makhathini, Ludwaba. Novel use of the Bakri postpartum balloon in gestational trophoblastic neoplasia with bleeding vaginal metastatic lesions refractory to conventional treatment modalities Southern African Journal of Gynaecological Oncology, 2024-06-01,16(1): 1-4 https://journals.co.za/doi/full/10.36303/SAJGO.384
- ^ Haslinger C, Weber K, Zimmermann R. Vacuum-Induced Tamponade for Treatment of Postpartum Hemorrhage. Obstet Gynecol. 2021 Sep 1;138(3):361-365. doi: 10.1097/AOG.0000000000004510. PMID 34352848; PMCID: PMC8366764.
- ^ Grönvall, Maiju; Tikkanen, Minna; Tallberg, Erika; Paavonen, Jorma; Stefanovic, Vedran (2013). "Use of Bakri balloon tamponade in the treatment of postpartum hemorrhage: A series of 50 cases from a tertiary teaching hospital". Acta Obstetricia et Gynecologica Scandinavica. 92 (4): 433–438. doi:10.1111/j.1600-0412.2012.01531.x. PMID 22913383. S2CID 2851504.
- ^ Diemert, Anke; Ortmeyer, Gerhard; Hollwitz, Bettina; Lotz, Manuela; Somville, Thierry; Glosemeyer, Peter; Diehl, Werner; Hecher, Kurt (2012). "The combination of intrauterine balloon tamponade and the B-Lynch procedure for the treatment of severe postpartum hemorrhage". American Journal of Obstetrics and Gynecology. 206 (1): 65.e1–65.e4. doi:10.1016/j.ajog.2011.07.041. PMID 22000893.
- ^ Xiao, C.; Wang, Y.; Zhang, N.; Sun, G. Q. (2023). "Bakri Balloon for Treatment of Postpartum Hemorrhage: A Real-World 2016–2020 Study in 279 Women from a Single Center". Medical Science Monitor. 29: e938823-1-e938823-9. doi:10.12659/MSM.938823. PMC 9987168. PMID 36855288.
- ^ Lalonde, André (May 2012). "Prevention and treatment of postpartum hemorrhage in low-resource settings". International Journal of Gynecology & Obstetrics. 117 (2): 108–118. doi:10.1016/j.ijgo.2012.03.001. PMID 22502595. S2CID 34206676.
- ^ WHO recommendation on uterine balloon tamponade for the treatment of postpartum haemorrhage. World Health Organization. 2021. hdl:10665/340796. ISBN 978-92-4-001384-1.[page needed]