The uterine sandwich for persistent uterine atony: combining the B-Lynch compression suture and an intrauterine Bakri balloon

Objective The objective of the study was to evaluate the effectiveness of a combination of surgical interventions for control of postpartum hemorrhage. Study Design At cesarean delivery, patients with persistent bleeding from uterine atony after the administration of oxytonics were treated with the...

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Bibliographic Details
Published in:American journal of obstetrics and gynecology 2007-05, Vol.196 (5), p.e9-e10
Main Authors: Nelson, Wendy L., MD, O’Brien, John M., MD
Format: Article
Language:English
Subjects:
compression suture
Female
Hemostasis, Surgical
Hemostatic Techniques
Humans
intrauterine balloon
Obstetrics and Gynecology
Oxytocics - therapeutic use
postpartum hemorrhage
Postpartum Hemorrhage - etiology
Postpartum Hemorrhage - surgery
Pregnancy
Suture Techniques
Uterine Inertia - drug therapy
Uterine Inertia - etiology
Uterine Inertia - surgery
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Summary:Objective The objective of the study was to evaluate the effectiveness of a combination of surgical interventions for control of postpartum hemorrhage. Study Design At cesarean delivery, patients with persistent bleeding from uterine atony after the administration of oxytonics were treated with the placement of a B-Lynch suture. When the B-Lynch failed, subsequent placement of an intrauterine Bakri balloon followed. This combination is termed the uterine sandwich. Results The uterine sandwich was successful for all 5 patients undergoing this approach. The median nadir hematocrit was 21.1% (range 20.1% to 28%). The balloon was in place for a median duration of 11hours (range10-24 hours). The median volume infused into the balloon was 100 mL (range 60- 250 mL). No complications were observed. Conclusion Placing an intrauterine Bakri balloon in conjunction with the B-Lynch uterine compression suture was successful in treating uterine atony.
ISSN:0002-9378
1097-6868
DOI:10.1016/j.ajog.2006.10.887