Abraham Cynthia
Hofstra University, Northwell Health System, Staten Island University Hospital, United States.
Int J Surg Case Rep. 2017;31:218-220. doi: 10.1016/j.ijscr.2017.01.055. Epub 2017 Jan 24.
Postpartum hemorrhage is an obstetric emergency that accounts for 25% of maternal deaths worldwide. Initial management consists of uterotonic administration but in cases in which there is a failure of response to medication, uterine cavity tamponade can be effective. This is the first reported case of successful Bakri balloon placement in the management of postpartum hemorrhage at the time of cesarean delivery in a patient with a bicornuate uterus.
The patient was a primigravid female who presented at 40 weeks and 1day gestation with known bicornuate uterus and findings suggestive of placental abruption. Labor was subsequently induced and magnesium was administered after a diagnosis of preeclampsia with severe features was made. Cesarean delivery was then performed for category II fetal heart rate tracing remote from delivery. Intraoperative course was significant for uterine atony unresponsive to oxytocin, carboprost, methylergonovine and misoprostol administration. The right uterine horn was noted to be markedly atonic compared to the left. A Bakri balloon was then placed transvaginally and inflated with 600mL of saline in this location. Atony then resolved.
Although uterine malformation is not a documented contraindication to Bakri balloon placement, there is no literature on its efficacy in the treatment of hemorrhage in the presence of this anomaly.
In the management of postpartum hemorrhage, Bakri balloon placement is associated with success in the presence of a bicornuate uterus. Care should be taken to direct insertion of the balloon in the appropriate location.
产后出血是一种产科急症，占全球孕产妇死亡人数的25%。初始治疗包括使用宫缩剂，但在药物治疗无效的情况下，宫腔填塞可能有效。这是首例报道的在剖宫产时成功放置Bakri球囊治疗双角子宫患者产后出血的病例。
患者为初产妇，孕40周零1天，已知双角子宫，有胎盘早剥迹象。随后引产，在诊断为重度子痫前期后给予硫酸镁治疗。因II类胎心监护远离分娩而进行剖宫产。术中子宫收缩乏力，对缩宫素、卡前列素、甲基麦角新碱和米索前列醇治疗无反应。与左侧相比，右侧子宫角明显收缩乏力。然后经阴道放置Bakri球囊，并在此处注入600mL生理盐水使其膨胀。子宫收缩乏力随后得到缓解。
虽然子宫畸形并非Bakri球囊放置的禁忌证，但尚无关于其在这种异常情况下治疗出血疗效的文献。
在产后出血的治疗中，双角子宫患者放置Bakri球囊取得了成功。应注意将球囊正确插入合适位置。
