[Efficiency of Bakri intra uterine tamponade balloon use in postpartum hemorrhage: Before and after study].

OBJECTIVE To assess the impact of the introduction of intrauterine balloon tamponade on second-line management practices for post-partum hemorrhage (PPH). METHOD This retrospective study was conducted in a tertiary care centre where arterial embolisation was not available. Two periods were compared, before (2008-2010) and after (2015-2017) the introduction of an intrauterine tamponade balloon protocol using the Bakri balloon. All consecutive patients with PPH refractory to sulprostone in the two periods were included. Outcomes studied were the incidence of invasive procedures (conservative surgery, embolisation, hysterectomy) as well as transfer to centres with arterial embolisation facilities. RESULTS A total of 109 patients had refractory PPH, 44 in the first period and 65 in the second period. The proportion of all PPH cases which required sulprostone did not differ between the periods (24.2 and 29.3%, respectively, P=0.25). There were significant decreases between the first and the second period in the proportion requiring a transfer to an embolisation centre (79.6% during period 1, vs. 6.2% respectively, P<0.001), embolisation (20.6% vs. 0%, P<0.001), uterine compression sutures (13.6% vs. 3.1% P=0.04) and surgical management (22.7% vs. 7.7%, P=0.025). The decrease in the incidence of hysterectomy did not reach statistical significance (11,4 vs. 1,5%, P=0.095). Among 29 cases of PPH following cesarean sections (14 in the first period and 15 in the second period), we observed a significant decrease in transfer rates (66.7% vs. 0%, P<0.01), as well as decreases in embolisation (26.7% vs. 0%, P=0.10) and invasive procedures (60% vs. 28.7%, P=0.089), which did not reach statistical significance. CONCLUSION The introduction of intrauterine tamponade was associated with a decrease in the need for invasive procedures. In a centre without access to on-site arterial embolisation, transfer rates were reduced improving patient comfort and reducing costs.