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Massive Hemorrhage From Suspected Iatrogenic Uterine Rupture

Nguyen, Kim T., MD; Lozada, M. James, DO; Gorrindo, Phillip, MD, PhD; Peralta, Feyce M., MD

doi: 10.1097/AOG.0000000000002971
Maternal Morbidity and Mortality: Case Report: PDF Only

BACKGROUND: Intrauterine balloon tamponade is recommended for refractory postpartum hemorrhage resulting from atony, but few studies have assessed complications associated with placement.

CASE: A 39-year-old woman, gravida 4 para 1, with posterior placenta previa and suspected placenta accreta had a postpartum hemorrhage after a scheduled cesarean delivery. An intrauterine balloon tamponade device was easily placed transcervically; however, the patient required additional analgesia for constant severe stabbing pain worsened on examination. Three hours after placement, the balloon was expelled from the cervix, resulting in 1,500 mL of fresh blood and clot. Emergent exploratory laparotomy identified a uterine rupture inferior and lateral to the hysterotomy site.

CONCLUSION: Intrauterine balloon tamponade may contribute to iatrogenic uterine rupture and should be considered in patients with refractory hemorrhage, hemodynamic instability, or severe pain despite analgesia.

Intrauterine balloon tamponade can contribute to uterine rupture and should be considered in a patient with refractory hemorrhage, hemodynamic instability, or severe postpartum pain.

Division of Obstetrical Anesthesiology, Department of Anesthesiology, and the Division of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and the Division of Obstetrical Anesthesiology, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.

Corresponding author: Kim T. Nguyen, MD, Northwestern University Feinberg School of Medicine, 251 E Huron, F5-704, Chicago, IL 60611; email: kim.nguyen@northwestern.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has indicated that he or she has met the journal's requirements for authorship.

Peer review history is available at http://links.lww.com/AOG/B185.

Presented at Society for Obstetric Anesthesia and Perinatology Annual Meeting, May 9–13, 2018, Miami, Florida.

Received June 20, 2018

Received in revised form September 03, 2018

Accepted September 13, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.