Abstract | November 12, 2020

The Novel Use of a Bakri Postpartum Balloon for the Use of Puerperal Uterine Inversion Avoiding Emergency Laparotomy

Presenting Author: Shona Malu Joseph, Bachelor of Science, OMS IV, Department of Obstetrics and Gyncecology, Nova Southeastern University, Fort Lauderdale, Florida

Co-authors: Allen Silanee, MD, FACOG, Department of Obstetrics and Gynecology, Mount Sinai Medical Center, Miami Beach, FL; Jack Ni, DO, Nova Southeastern University, Fort Lauderdale, FL

Learning Objectives

  1. Upon completion of this lecture, learners should be prepared to discuss novel uses for the Bakri postpartum balloon for acute puerperal uterine inversion.
  2. Upon completion of this lecture, learners should be prepared to identify the current treatment modalities for acute puerperal uterine inversion.

Introduction: Puerperal uterine inversion occurs when the fundus collapses into or even beyond the endometrial cavity, resulting in the uterus either partially or completely turning inside out. It is regarded as a life-threatening obstetric emergency due to severe hemorrhaging. The current treatment recommendations include manually manipulating the uterine inversion and surgical intervention.

Case Presentation: We present a case of a 32-year-old female, G2 T1 P0 A0 L1, who was delivering her second child vaginally. The gestational age was 39 weeks and 2 days. Upon admission, she denied nausea, vomiting, fever, chills, and diarrhea. The patient had an uneventful stage 1 and 2 of labor. After delivery of the infant, the placenta began to deliver. It was also noted that the uterus was inverting. At this point, the placenta was immediately removed in a piecemeal fashion.

Final/Working Diagnosis: Once the placenta was removed, heavy bleeding was noted due to a fourth degree inversion and the uterine fundus was returned to the normal position via manual replacement. The maneuver significantly decreased the bleeding; however, the fundus remained hypotonic and would invert again after completion of the maneuver. The final diagnosis was acute puerperal uterine inversion.

Management/Outcome/and or Follow-up: Fundal massage and uterine hypertonic agents did not resolve the inversion. Aggressive fluid replacement with IVF, FFP, and PRBC continued but was not successful. The patient was taken to the OR to undergo an emergency laparotomy. In a final effort to avoid surgery, a Bakri uterine balloon was inserted in an attempt to maintain the position of the fundus. While manually maintaining the fundal position, the balloon was inserted through the cervix into the uterus. While 240 cc of sterile saline was inflated into the balloon, the hand was removed from the uterus. This resulted in the Bakri balloon maintaining the fundal position and controlling the bleeding. The patient was monitored for three days with no significant complications. The Bakri balloon was gradually deflated and eventually removed. Thus, the Bakri postpartum balloon may be used in puerperal uterine inversion, avoiding the need for emergency laparotomy.\

Uterine Inversion Demo Video

Figures 1 & 2

Posted in: Obstetrics and Gynecology9 Mental Health7 Women’s & Children’s Health27