Prophylactic application of Bakri balloon tamponade versus uterine gauze packing during cesarean section in patients with placenta previa

Abstract Bakri balloon implementations for the conservative management of postpartum hemorrhage (PPH) have become more popular in the recent years. The procedure may be regarded as simple, however, it can become a challenging method considering an excessive bleeding patient where there is a race against time. In our daily practice we do not usually use the lithotomy position except for few conditions such as placenta previa, where the lithotomy position is necessary to apply a Bakri balloon during PPH during a cesarean section. Here we would like to present a woman with uterine atony and fundal placenta accreta bleeding, managed with the Bakri balloon without switching to the lithotomy position for the first time in the literature. The bleeding was evaluated successfully with this new method, however, a cesarean hysterectomy was necessary to achieve hemostasis despite the addition of a bilateral uterine artery ligation at the end. The decision to add a vessel ligation to the inflated Bakri balloon should be assessed carefully as uterine artery ligation may be time consuming due to effort of avoiding puncturing the balloon. On the other hand, internal illiac artery ligation may be more advantageous if the surgeon is experienced.

Download Full-text

Intrauterine Gauze Packing in Primary Post Partum Hemorrhage following Caesarean section: A Clinical study

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v7i1.8833 ◽

2013 ◽

Vol 7 (1) ◽

pp. 33-36

Author(s):

Shao Yong ◽

M Pradhan

Keyword(s):

Cesarean Section ◽

Cesarean Delivery ◽

Placenta Previa ◽

Post Partum ◽

Cost Effective ◽

Invasive Technique ◽

Safe Procedure ◽

Post Partum Hemorrhage ◽

Gauze Packing ◽

A Prospective Study

Aims: To study the effectiveness of uterine gauze packing to manage and prevent primary postpartum haemorrhage during cesarean delivery. Methods: This was a prospective study that was conducted in the department of obstetrics and gynecology, first affiliated hospital of Chongqing Medical University from Jan to May 2011. Patients included in the study were those with intractable postpartum hemorrhage not responding to medical treatment and for prevention of hemorrhage that could develop during cesarean section. Exclusion criteria included cases of ruptured uterus and vaginal deliveries.Packing was done using 2 m long and 10 cm wide sterilized gauze from the fundus through the cesarean incision with its end passing through cervix into the vagina and left for 24-48 hours or removed earlier in cases of failure to control hemorrhage. Results: Intrauterine gauze packing during cesarean section to arrest primary postpartum hamorrhage is a successful non-invasive technique. Intractable primary postpartum hamorrhage encountered in 42 (30.9%) cases had PPH after cesarean section. Placenta previa found in 48 (35.3%) cases unresponsive to uterotonics drugs was the commonest cause of uterine gauze packing. Intrauterine gauze packing was successful in 130 (95.6%) cases. Conclusions: Uterine packing is a cost effective, quick and safe procedure to manage and prevent primary PPH during cesarean delivery. Uterine packing is of benefit in achieving hemostasis particularly in cases of post partum hemorrhage due to low-lying placenta previa/accreta associated with lower segment bleeding conserving the uterus in women with cesarean delivery. Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 1 / Issue 13 / Jan- June, 2012 / 33-36 DOI: http://dx.doi.org/10.3126/njog.v7i1.8833

Download Full-text