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RCOG World Congress 2023
June 12 - 14, 2023 | London, UK
EP.0166
Bakri Balloon, Brace Suture and “Sandwich Technique” for Management of Post-Partum Haemorrhage
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Bakri Balloon, Brace Suture and “Sandwich Technique” for the Management of Severe Post-Partum Haemorrhage
E Tsiampousi, F Amanah-Salih, H Welch, N Gupta, Y Thakur, E Chandraharan
INTRODUCTION
•Post-Partum Haemorrhage (PPH): leading cause of maternal mortality and morbidity
•Severe PPH: ≥ 2000mL blood loss in the postnatal period
•75-90% of PPHs is contributed to uterine atony, which is usually managed with pharmacological agents (uterotonics)
•Uterine-sparing PPH management: 1) Bakri Balloon (BB) 2) Brace Suture (BS) 3) Combination of Two (Sandwich Technique – BB&BS)
•Aim of study: Determine possible difference in effectiveness of BB, BS or BB&BS in severe PPH management when pharmacological intervention has failed (study conducted in Basildon University Hospital)
METHODOLOGY
•Retrospective review of 37 case notes where pharmacological treatment failed to control PPH
•Effectiveness of management measured through blood tests (Haemoglobin Hb, Haematocrit Hct, Hemocue Hc), units of Red Blood Cells (RBC) transfused, patient observations (translated into Shock Index SI) and Days of Hospital Stay
•Inclusion criteria: 1) Caesarean Section, 2) Severe PPH, 3) Atony the primary cause of PPH, 4) No return to theatre for complications or hysterectomy
SUMMARY OF RESULTS
•ALL surgical methods equal (p-values > .05) (see Table 1)
•Shock Index (60 minutes) for BB&BS significantly lower (p = .0506)
•RBC in BB&BS 50% less (p = .4810)
•Blood loss (%) higher for the BB&BSgroup (p = .4377)
•BB&BS: least number of “events” with 1 case of abdominal collection and a future presentation of ectopic pregnancy (see Table 2)
DISCUSSION
•Potential superiority of BB&BS; less complications, blood transfusion, haemodynamic instability despite higher blood loss
•Non-randomised retrospective study: BB and BS of equal effectiveness(p = 0.01) (Kong et al., 2021)
•Systematic review: BB, BS of no statistically significant difference (p = 0.06) (Doumouchtsis et al., 2006)
•Study’s unique features: 1) SI (Heart rate/Systolic Blood pressure) incorporated; better reflexion of haemodynamic stability 2) Blood loss adjusted to patient’s weight