Conservative management of a recurrent puerperal uterine inversion with bakri<sup>®</sup> balloon tamponade

Abstract

Puerperal Uterine Inversion (PUI) is a rare but potentially life-threatening delivery complication in which the uterine fundus collapses within the endometrial cavity. This "glove-finger" introflexion of uterine walls generally occurs as an immediate postpartum complication and is responsible of different degrees of vaginal bleeding, shock and hypogastric pain that can cause serious maternal complications, including death. There are few reports of recurrent postpartum uterine inversion like the one we present here, and its causes remain unclear. Early diagnosis of this complication is crucial as it is the only one measure that can allow a successful and conservative treatment: an inverse relationship between the time that uterus keeps inverted and the probability of repositioning has been firmly established. This case report describes the exceptional and innovative use of the SOS Bakri ® balloon (Cook Medical Incorporated) in the management of a recurrent puerperal uterine inversion. To our knowledge it is one of the first reports in the world of this procedure, perhaps the second one after Soleymani's et al description; and the first one in a third degree recurrent puerperal uterine inversion.

Recurrent Puerperal Uterine Inversion

“…In 2009, Soleymani MH et al have reported first successful management of recurrent uterine inversion with Surgical Obstetric Silicone bakri balloon; then by Elósegui JJH et al in 2011. 3,4 Kabir N et al and Sharma N et al have reported acute uterine inversion managed by Johnson's maneuver; then subacute uterine inversion by Haultain's operation (cervical ring is posteriorly incised to facilitate uterine replacement by Huntington method). 5,6 Another case report of successful management of recurrent puerperal uterine inversion was managed first by Jhonson's maneuver for acute inversion and for recurrent uterine inversion exploratory laparotomy was done to reposit by Huntington technique (progressive upward traction on each round ligament by application of atraumatic clamps with simultaneous upward pressure transvaginally) and multiple Cho suture; bilateral uterine arteries and utero ovarian arteries were ligated prophylactically.…”