Successfulness of the Bakri intrauterine balloon for uterotonic-unresponsive postpartum haemorrhage treatment: systematic review and meta-analysis.

OBJECTIVE: The main purpose of this meta-analysis was to evaluate the success rate of Bakri balloon in controlling postpartum haemorrhage (PPH) unresponsive to uterotonics.
MATERIALS AND METHODS: We performed a literature search using the MEDLINE (accessed via PubMed) database from inception to October 2019, for clinical trials and observational studies. Case reports with six or fewer patients, review articles, letters to editor, use of the device for purposes different than PPH, and non-English language publications were excluded. Two authors independently extracted the data. Meta-analysis was performed using the random-effects model. Risk of bias was assessed by the Newcastle-Ottawa Scale. Primary outcome was the efficacy of the Bakri balloon in the treatment of PPH unresponsive to uterotonics.
RESULTS: Twenty-eight publications (n=1868 applications of Bakri balloon) met the inclusion criteria for the meta-analysis. Ten reports provided the frequency of Bakri balloon used during the study period, with the overall rate being 0,335% (1004/299124; 95% CI, 0.2–0.4%). Success rate of the haemostatic balloon in controlling PPH without the need for additional procedures was 82% (1597/1868; 95% CI, 78–86%), while further procedures were needed for 271 patients (13,83%; 95% CI, 11–21%). Bakri balloon plus additional procedures were effective in the control of the PPH in the 95% of all cases (1645/1868; 95% CI, 93–98%). Hysterectomy was performed in the 5% (78/1597; 95% CI, 2–6%) of all women who needed a Bakri balloon.
CONCLUSIONS: Bakri balloon represents a successful therapeutic option for the treatment of postpartum haemorrhage unresponsive to uterotonics.