Bakri Balloon Inflation Volume for Postpartum Hemorrhage
The Bakri balloon should be inflated with 300-500 mL of saline initially, with volumes adjusted up to 500-600 mL or higher (maximum 800 mL per manufacturer specifications) based on cessation of bleeding, particularly in cases of uterine atony where volumes exceeding 500 mL are frequently necessary. 1, 2
Initial Inflation Strategy
- Start with 300-500 mL of saline and assess for hemostasis by monitoring drainage through the balloon's lumen 1, 3
- The median inflation volume across multiple studies ranges from 200-345 mL, but this represents the final volume after titration, not the starting point 3, 4
- Monitor for cessation of bleeding through the drainage channel - continued bleeding indicates need for additional volume 4
Volume Titration Based on PPH Etiology
Uterine Atony (Most Common Indication)
- Volumes >500 mL are frequently required - one study found 18 of 34 patients with atony needed inflation volumes exceeding 500 mL 1
- Mean inflation volumes in atony cases: 571 ± 264 mL (range 240-1300 mL) 1
- In one case report of bicornuate uterus with severe atony, 600 mL was required for successful tamponade 2
Placenta Previa or Low-Lying Placenta
- Lower volumes are typically sufficient (median 200-345 mL range) due to more localized bleeding source 3, 4
- The spindle shape of the Bakri balloon provides better conformability to hemorrhagic areas in these cases 4
Critical Technical Points
- Inflate incrementally while monitoring - add 100 mL aliquots until bleeding stops as evidenced by minimal drainage through the lumen 1, 4
- The balloon's drainage lumen allows real-time assessment of ongoing blood loss even after insertion, which is a key advantage over other tamponade devices 4
- Maximum safe volume is 800 mL per manufacturer specifications, though volumes up to 1300 mL have been reported in literature without complications 1
Common Pitfalls to Avoid
- Underinflation is a primary cause of failure - if bleeding continues through the drainage port, additional volume is needed rather than proceeding immediately to surgical intervention 1
- In bicornuate or malformed uteri, ensure the balloon is directed into the appropriate uterine horn where atony is most severe 2
- Balloon displacement occurs in approximately 9% of cases (95% CI: 5-15%), often due to inadequate inflation volume 5
Success Rates and Outcomes
- Overall success rate with appropriate volume titration: 88.8-90% in avoiding hysterectomy 1, 4
- Success rate specifically for uterine atony: 79.4% with balloon alone, increasing to 88.2% when combined with additional procedures 1
- Mean blood loss after balloon insertion drops dramatically from 2,732 ± 1,397 mL to 380 ± 376 mL 4