We read with great interest your series on the use of Bakri balloon tamponade for postpartum hemorrhage (PPH) and commend you for encouraging the use of this simple technique (1). We would like to share our data on 43 cases of massive PPH (>2000 mL) in which balloon tamponade was attempted between 2007 and 2012 at an inner city London hospital. In our own series of 43 women, Bakri balloon tamponade succeeded in abating hemorrhage in 93% of cases, obviating the need for hysterectomy. Of these, 14 women (32.6%) required an additional procedure, i.e. the combined "uterine sandwich" technique which is usually performed when tamponade alone fails to control bleeding (2); of these, two cases proceeded to hysterectomy (14.3%). Interestingly, 81.4% of our cases occurred following cesarean section and balloons were introduced via the abdominal route. Mean estimated blood loss for these 43 cases was 3400 mL and mean duration of the balloons remaining in situ was 22 h. The standard procedure at our institution is for inflation of the balloon with 350 mL saline.
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