Bakri Balloon: An Adjunct in Emergency Public Health- A Case Report
Prerna Kherajani, Vidhi Vora, Krish Kherajani, Pratik Agarwal
OBJECTIVE
•More than 2/3rds of reported maternal haemorrhage deaths are due to postpartum haemorrhage(PPH).
•In low resource public health settings of countries such as India, a condom-UBT(Uterine Balloon Tamponade) is preferred for refractory atonic PPH due to the cost-effectiveness based on the DALYs averted.
•However, the Bakri balloon carries an advantage of proper conformability, blood loss monitoring, sterility, easy insertion and low slip-out rates. We present a case of a woman with refractory PPH managed with Bakri balloon UBT.
•The patient is a 24 year old primigravid female at 33 weeks of pregnancy.
•She was a known case of pre-eclampsia on Tab. Alpha-methyldopa for the same.
• She presented to the hospital with active preterm labour and a history of jaundice and abdominal pain for 15-20 days.
•On examination, the patient was pallid and icteric with a BP of 80/50mmHg and active per vaginal bleeding. Investigations showed a raised bilirubin and hepatic enzymes. Her blood count showed an increased WBC count(12,400 cumm) and decreased platelets(57,00 cumm) along with a raised PT/INR(23/2.25). Figure 2 shows the patient’s detailed hematological investigations.
•Post imaging, a diagnosis of Acute Fatty Liver of Pregnancy was made.
•The patient was given 12mg Betamethasone, 4 units of FFP and monitored for spontaneous labour progression.
•The patient went into atonic PPH after delivery. An initial medical management including Inj. Oxytocin, Tab. Misoprostol and Inj. Carboprost was ineffective in controlling the haemorrhage. A Bakri balloon was inserted as a modality for balloon tamponade to the atonic uterus. The patient’s condition improved and the PPH was under control.
DISCUSSION
•The case reports the use of Bakri balloon tamponade in a low resource country setting to manage refractory atonic PPH. It points to an effective use-case in situations where the patient has experienced significant blood loss and a dependable tamponade device is required to prevent maternal mortality.
•We advocate the use of Bakri balloons in a low resource public health setting in scenarios where a definite stoppage of refractory PPH has to be achieved using tamponade.
•This will not be possible unless a definite amount of these devices are maintained at these setups for such scenarios.
TAKE HOME MESSAGE
•Our research paves way for further literature and decisions into policy making to include Bakri balloon; not as a replacement to the ongoing cheaper alternatives, but as an adjunct in critical therapy of the patients.
REFERENCES
Parts of the figure were drawn by using pictures from Servier Medical Art. Servier Medical Art by Servier is licensed under a Creative
Commons Attribution 3.0 Unported License
(https://creativecommons.org/licenses/by/3.0/).
• Wang Y, Xiao C, Zhang N, Sun G. Performance of Bakri balloon tamponade in controlling postpartum hemorrhage. Am J Transl Res. 2023
Mar 15;15(3):2268-2279. PMID: 37056856; PMCID: PMC10086883.
