A multicenter study on the efficacy of Bakri balloon in the prevention and treatment of postpartum hemorrhage with different etiologies

doi:10.3877/cma.j.issn.2095-3259.2025.03.006

Chinese Journal of Obstetric Emergency(Electronic Edition) ›› 2025, Vol. 14 ›› Issue (03): 152-160. doi: 10.3877/cma.j.issn.2095-3259.2025.03.006

• Original Article • Previous Articles

A multicenter study on the efficacy of Bakri balloon in the prevention and treatment of postpartum hemorrhage with different etiologies

Huili Zhang¹, Yuan Jiang², Lili Du¹, Yipeng Sun³, Fang He¹, Lin Yu¹, Dong Han¹, Zhijian Wang⁴, Ling Ai⁵, Yanli Liu⁶, Jun Han⁷, Qiwei Luo⁸, Zhongjun Li⁹, Huijing Zeng¹⁰, Fengmei Jin¹¹, Yujie Gan¹², Lanzhen Zhang¹³, Bo Wan¹⁴, Ping Chen¹⁵, Hongyan Cui¹⁶, Ye Xu¹⁷, Hua Zhang¹⁸, Jianli Wu¹⁹, Jiangping Liu²⁰, Ganyi Tong²¹, Jing Li²², Wei Cai²³, Qiaohong Lai²⁴, Zhihui He²⁵, Shijie Lv²⁶, Bo Sun²⁷, Jianying Yan²⁸, Jieyun He²⁹, Xuxia Liang³⁰, Qiying Zhu³¹, Jianli Wu³¹, Yun Chai³², Qiongshan Li³³, Zhiqin Wu³⁴, Li Dai³⁵, Zeguo Dai³⁶, Lifang Chen³⁶, Chuyi Chen², Yue′e Chen², Jingyu Liu², Xiuhua Zhou², Shrestha Mandakini¹, Dunjin Chen¹^,^*()

¹Guangdong Key Laboratory of Major Diseases of Obstetrics; Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology; Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine; The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, China
²The Third Clinical College, Guangzhou Medical University, Guangzhou 510182, China
³The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China
⁴Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
⁵Jiaxing Maternity and Child Health Care Hospital, Jiaxing 314009, China
⁶Guangdong Provincial People′s Hospital, Guangzhou 510080, China
⁷Guangzhou Hospital of Integrated Traditional and Western Medicine, Guangzhou 510800, China
⁸Panyu He Xian Memorial Hospital of Guangdong Medical University, Guangzhou 511400, China
⁹Dongguan People′s Hospital, Dongguan 523000, China
¹⁰Guangzhou Women and Children′s Medical Center, Guangzhou 510623, China
¹¹Zhuhai Maternity and Child Health Hospital, Zhuhai 519000, China
¹²Boai Hospital of Zhongshan, Zhongshan 528402, China
¹³The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China
¹⁴The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
¹⁵Huizhou First Maternal and Child Health Care Hospital, Huizhou 516001, China
¹⁶Tianjin Central Hospital of Gynecology Obstetrics, Tianjin 300052, China
¹⁷Nanhai Maternity and Child Healthcare Hospital of Foshan, Foshan 528200, China
¹⁸The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
¹⁹Tongji Hospital, Tongji Medical College of HUST, Wuhan 430032, China
²⁰Jiangxi Provincial People′s Hospital, Nanchang 330006, China
²¹Huizhou Sixth People′s Hospital, Huizhou 516200, China
²²Jiangmen Maternal and Child Health Care Hospital, Jiangmen 529000, China
²³Zhujiang Hospital of Southern Medical University, Guangzhou 510280, China
²⁴Xiaolan People′s Hospital of Zhongshan, Zhongshan 528415, China
²⁵The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
²⁶Dalian Obstetrics and Gynecology Hospital, Dalian 116021, China
²⁷Shenzhen Baoan Women′s and Children′s Hospital, Shenzhen 518100, China
²⁸Fujian Maternity and Child Health Hospital, Fuzhou 350001, China
²⁹Shunde Women′s and Children′s Hospital of Guangdong Medical University, Foshan 528300, China
³⁰The People′s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
³¹The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830013, China
³²Hangzhou Maternal and Child Health Hospital, Hangzhou 310008, China
³³Huzhou Maternal and Child Health Care Hospital, Huzhou 313000, China
³⁴General Hospital of the Xinjiang Military Command of PLA, Urumqi 830099, China
³⁵Shenzhen Longhua District Maternal and Child Health Hospital, Shenzhen 518109, China
³⁶Lufeng People′s Hospital, Shanwei 516500, China

Received:2024-05-14 Online:2025-08-18 Published:2025-09-16
Contact: Dunjin Chen

Abstract

Abstract:

Objective

To explore the clinical efficacy of the Bakri intrauterine balloon (BIUB) in preventing and treating postpartum hemorrhage(PPH) caused by different etiologies.

Methods

A retrospective study was conducted on 724 postpartum hemorrhage patients treated at 31 hospitals across 9 provinces in China from November 2018 to September 2019. Clinical data included age, height, pre-pregnancy weight, parity, gestational age at delivery, pregnancy complications and comorbidities was collected. Patients were divided into three groups based on PPH etiology: (1) Group A, with 308 cases of PPH caused by uterine atony; (2) Group B, 211 cases of PPH caused by placental factors; (3) Group C, 205 cases of PPH caused by coagulation dysfunction. General situation, bleeding volume before and after balloon placement, changes in related indicators of blood routine examination, and hemostatic efficacy of Bakri balloon were compared among groups.

Results

(1) General situation: There were statistically significant differences in the average age [(31.43±4.95)years vs(32.27±4.82)years vs(33.17±5.07)years, P<0.001)], twin pregnancy [62 (20.13%) vs 11 (5.21%) vs 21 (10.24%), P<0.001], gestational weeks of delivery [(37.39±2.75)weeks vs (36.13±2.56)weeks vs (36.62±2.56) weeks, P<0.001], preterm delivery [76 (24.68%) vs 83 (39.34%) vs 79 (38.54%), P<0.001], cesarean delivery [215 (69.81%) vs 178 (84.36%) vs 150 (73.17%), P<0.001], prenatal red blood cell count [(3.92±0.63)×10¹²/L vs (3.74±0.69)×10¹²/L vs (3.79±0.67)×10¹²/L, P=0.007], hemoglobin [(111.98±16.18)g/L vs (108.66±15.92)g/L vs (107.00±19.76)g/L, P=0.006], hematocrit [(0.35±0.09)%vs (0.34±0.07)% vs(0.33±0.06)%, P=0.033], and mean corpuscular volume(MCV) levels [(86.46±11.20)fl vs (89.04±7.21)fl vs (85.55±11.97)fl, P=0.002] among the three groups of patients. No statistically significant difference were found in pre-pregnancy weight, parity, prenatal mean corpuscular hemoglobin(MCH), mean corpuscular hemoglobin concentration(MCHC), and pre-balloon hemorrhage (P>0.05). (2) Changes in blood routine related indicators: There were no statistically significant changes in red blood cell count, hemoglobin, hematocrit, average red blood cell volume, and average red blood cell hemoglobin concentration among the three groups of patients before and after balloon placement (P>0.05). (3) Hemostatic effect: hemostatic success rates after balloon placement were 98.05%, 97.63%, and 96.59%, respectively. There was no significant difference in the success rate and incidence of complications of Bakri balloon hemostasis among the three groups of patients (P>0.05).

Conclusions

The Bakri balloon effectively achieves rapid hemostasis for PPH caused by uterine atony, placental factors, and coagulation dysfunction, demonstrating particular suitability for uterine atony. However, its efficacy is limited in cases of severe PPH.

Key words: Uterine balloon packing, Postpartum hemorrhage, Multicenter research

Huili Zhang, Yuan Jiang, Lili Du, Yipeng Sun, Fang He, Lin Yu, Dong Han, Zhijian Wang, Ling Ai, Yanli Liu, Jun Han, Qiwei Luo, Zhongjun Li, Huijing Zeng, Fengmei Jin, Yujie Gan, Lanzhen Zhang, Bo Wan, Ping Chen, Hongyan Cui, Ye Xu, Hua Zhang, Jianli Wu, Jiangping Liu, Ganyi Tong, Jing Li, Wei Cai, Qiaohong Lai, Zhihui He, Shijie Lv, Bo Sun, Jianying Yan, Jieyun He, Xuxia Liang, Qiying Zhu, Jianli Wu, Yun Chai, Qiongshan Li, Zhiqin Wu, Li Dai, Zeguo Dai, Lifang Chen, Chuyi Chen, Yue′e Chen, Jingyu Liu, Xiuhua Zhou, Shrestha Mandakini, Dunjin Chen. A multicenter study on the efficacy of Bakri balloon in the prevention and treatment of postpartum hemorrhage with different etiologies[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2025, 14(03): 152-160.

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References 24

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组别	例数	年龄(岁，±s)	孕前体重(kg，±s)	产次[例(%)]		妊娠胎儿数[例(%)]
组别	例数	年龄(岁，±s)	孕前体重(kg，±s)	初产	经产	单胎	多胎
A组	308	31.43±4.95	56.03±9.12	121(39.29)	187(60.71)	246(79.87)	62(20.13)
B组	211	32.27±4.82	56.12±8.94	73(34.60)	138(65.40)	200(94.79)	11(5.21)
C组	205	33.17±5.07^a	57.54±10.14	69(33.66)	136(66.34)	184(89.76)	21(10.24)
统计值		F＝7.280	F＝1.040	χ²＝2.232		χ²＝24.077
P值		<0.001	0.353	0.328		<0.001
组别	例数	分娩孕周(周，±s)	是否早产[例(%)]		分娩方式[例(%)]		妊娠期贫血[例(%)]血红蛋白<110 g/L
组别	例数	分娩孕周(周，±s)	是	否	剖宫产	阴道分娩	妊娠期贫血[例(%)]血红蛋白<110 g/L
A组	308	37.39±2.75	76(24.68)	232(75.32)	215(69.81)	93(30.19)	127(41.23)
B组	211	36.13±2.56^a	83(39.34)^b	128(60.66)	178(84.36)	33(15.64)	107(50.71)
C组	205	36.62±2.56^a	79(38.54)^b	126(61.46)	150(73.17)	55(26.83)	107(52.20)
统计值		F＝10.540	χ²＝16.259		χ²＝14.658		χ²＝7.113
P值		<0.001	<0.001		<0.001		0.028

组别	例数	年龄(岁，±s)	孕前体重(kg，±s)	产次[例(%)]		妊娠胎儿数[例(%)]
组别	例数	年龄(岁，±s)	孕前体重(kg，±s)	初产	经产	单胎	多胎
A组	308	31.43±4.95	56.03±9.12	121(39.29)	187(60.71)	246(79.87)	62(20.13)
B组	211	32.27±4.82	56.12±8.94	73(34.60)	138(65.40)	200(94.79)	11(5.21)
C组	205	33.17±5.07^a	57.54±10.14	69(33.66)	136(66.34)	184(89.76)	21(10.24)
统计值		F＝7.280	F＝1.040	χ²＝2.232		χ²＝24.077
P值		<0.001	0.353	0.328		<0.001
组别	例数	分娩孕周(周，±s)	是否早产[例(%)]		分娩方式[例(%)]		妊娠期贫血[例(%)]血红蛋白<110 g/L
组别	例数	分娩孕周(周，±s)	是	否	剖宫产	阴道分娩	妊娠期贫血[例(%)]血红蛋白<110 g/L
A组	308	37.39±2.75	76(24.68)	232(75.32)	215(69.81)	93(30.19)	127(41.23)
B组	211	36.13±2.56^a	83(39.34)^b	128(60.66)	178(84.36)	33(15.64)	107(50.71)
C组	205	36.62±2.56^a	79(38.54)^b	126(61.46)	150(73.17)	55(26.83)	107(52.20)
统计值		F＝10.540	χ²＝16.259		χ²＝14.658		χ²＝7.113
P值		<0.001	<0.001		<0.001		0.028

组别	例数	RBC(×10⁹/L，±s)	HGB(g/L，±s)	HCT(%，±s)	MCV(fl，±s)	MCH(pg，±s)	MCHC(g/L，±s)
A组	308	3.92±0.63	111.98±16.18	0.35±0.09	86.46±11.20^b	29.39±5.46	326.31±39.59
B组	211	3.74±0.69^a	108.66±15.92^a	0.34±0.07	89.04±7.21	29.58±5.30	324.65±38.20
C组	205	3.79±0.67^a	107.00±19.76^a	0.33±0.06^a	85.55±11.97^b	28.85±6.00	322.28±43.25
F值		4.96	5.08	3.43	6.16	0.91	0.56
P值		0.007	0.006	0.033	0.002	0.404	0.573

组别	例数	RBC(×10⁹/L，±s)	HGB(g/L，±s)	HCT(%，±s)	MCV(fl，±s)	MCH(pg，±s)	MCHC(g/L，±s)
A组	308	3.92±0.63	111.98±16.18	0.35±0.09	86.46±11.20^b	29.39±5.46	326.31±39.59
B组	211	3.74±0.69^a	108.66±15.92^a	0.34±0.07	89.04±7.21	29.58±5.30	324.65±38.20
C组	205	3.79±0.67^a	107.00±19.76^a	0.33±0.06^a	85.55±11.97^b	28.85±6.00	322.28±43.25
F值		4.96	5.08	3.43	6.16	0.91	0.56
P值		0.007	0.006	0.033	0.002	0.404	0.573

组别	例数	≤400 ml	401～800 ml	801～999 ml	≥1 000 ml
A组	308	55(17.86)	148(48.05)	90(29.22)	15(4.87)
B组	211	48(22.75)	105(49.76)	43(20.38)	15(7.11)
C组	205	34(16.59)	85(41.46)	69(33.66)	17(8.29)
χ²值		13.311
P值		0.038

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