Background: The aim of this study was to identify risk factors of Bakri balloon tamponade (BBT) failure for postpartum hemorrhage (PPH) and to evaluate the efficacy of BBT for PPH caused by different etiologies. Methods: All women who underwent BBT for PPH at International Peace Maternity & Child Healthcare Hospital, Shanghai, China were included. Univariate analysis and logistic multivariate models were used to identify prognostic factors for BBT failure. Results: Of 48,511 deliveries during the study period, 487 (1.0%) women underwent BBT for persistent PPH. The overall success rate was 91.8% (447/487). The individual success rates of BBT for PPH caused by uterine atony, placenta previa, placenta accreta spectrum (PAS), and coagulopathy were 95.9%, 90.6%, 50.0%, and 25.0%, respectively. Blood loss before BBT was remarkably higher in the failure group than in the success group. In addition, estimated blood loss (EBL) before BBT insertion, disseminated intravascular coagulation (DIC) development, in vitro fertilization (IVF) pregnancy, and PAS were considered to be independent risk factors of BBT failure. Conclusions: BBT is an effective method in the management of PPH resulting from uterine atony and placenta previa. Risk factors of BBT failure primarily include the EBL before BBT insertion, DIC development, IVF pregnancy and PAS.