Bakri Balloon Removal Timing in Postpartum Hemorrhage
The Bakri balloon should be removed after 24 hours of placement once bleeding has been controlled and the patient is hemodynamically stable. 1, 2
Standard Removal Protocol
- Remove the balloon at 24 hours post-placement as this is the standard duration supported by multiple studies showing successful outcomes 1, 2, 3
- The median retention time in successful cases is approximately 22 hours, with most protocols using a 24-hour window 1
- Do not remove the balloon earlier than 24 hours unless there is a specific complication requiring removal, as premature removal may lead to recurrent bleeding 1
Pre-Removal Assessment
Before removing the Bakri balloon, confirm the following:
- Bleeding has been controlled with no ongoing hemorrhage through or around the balloon 1, 3
- Hemodynamic stability has been achieved and maintained 4
- Uterine tone has improved and the uterus remains well-contracted 3
- Laboratory parameters show stabilization (though hemoglobin drop-off alone should not delay removal if bleeding is controlled) 1
Removal Technique
- Deflate the balloon gradually rather than rapidly to assess for any recurrent bleeding 2
- Monitor the patient closely during and immediately after deflation for signs of renewed hemorrhage 3
- Have uterotonics readily available in case bleeding recurs upon balloon removal 4
Early Removal Indications (Before 24 Hours)
Remove the balloon earlier than 24 hours only if:
- Persistent bleeding continues despite balloon placement (median removal time in failure cases is 3 hours) 1
- Signs of infection develop (though this is rare with proper technique) 1
- The balloon causes patient intolerance or complications requiring removal 3
Post-Removal Monitoring
- Continue close observation for at least 2-4 hours after balloon removal to detect any recurrent bleeding 3
- Maintain IV access and have blood products available during this period 4
- Perform ultrasound evaluation at 6 weeks postpartum to ensure no retained complications 1
Important Caveats
The 24-hour timeframe represents the optimal balance between allowing adequate uterine compression for hemostasis while minimizing infection risk. Studies show no intrauterine infections occurred with this protocol, and all patients had normal pelvic ultrasounds at follow-up 1. Retention times significantly differ between success (22 hours) and failure groups (3 hours), indicating that early removal is typically associated with treatment failure 1.