Uterine Balloon Tamponade Device and Cervical Cerclage to Correct Partial Uterine Inversion during Puerperium; Case Report

Abstract

A healthy 26-year-old woman was noted to have residual uterine inversion after manual replacement of puerperal uterine inversion under general anaesthesia. This was corrected by the insertion of a balloon tamponade device. A cervical suture was applied to prevent ballooning of the device through the cervix. This little modification was immediately successful in preventing ballooning of the tamponade device. The whole idea was to overcome the need for a laparotomy. A review of the literature and the mechanism of action are discussed here.

Post-partum complete acute uterine inversion: A coordinated multi-disciplinary approach ameliorates an obstetric nightmare, a case report

“…[ 5 ] It is termed acute (within 24 h postpartum), subacute (between 24 h and 1 month postpartum) and chronic (after 1 month postpartum). [ 4 7 ] Although a majority of them present with no identifiable risk factors, it can be caused due to precipitate labour, manual removal of placenta, traction on a short cord, straining or coughing while the uterus is lax especially in the setting of connective tissue disorders. [ 4 6 7 8 9 11 ] The clinical diagnosis usually includes the triad: haemorrhage, shock and pelvic pain and any health care provider performing delivery even at primary health centres must keep this in mind.…”

“…[ 4 7 ] Although a majority of them present with no identifiable risk factors, it can be caused due to precipitate labour, manual removal of placenta, traction on a short cord, straining or coughing while the uterus is lax especially in the setting of connective tissue disorders. [ 4 6 7 8 9 11 ] The clinical diagnosis usually includes the triad: haemorrhage, shock and pelvic pain and any health care provider performing delivery even at primary health centres must keep this in mind. [ 2 ] Sudden onset of significant vaginal bleeding, severe abdominal pain with strong bearing down sensation after delivery should alert them to possible uterine inversion.…”

“…[ 5 11 ] Surgical options include Huntington’s or Haultain’s operation, is sought only when the formation of a tight constriction ring precludes the aforementioned methods of uterine reposition. [ 1 4 5 9 12 ] In intractable cases hysterectomy is the last resort. [ 6 7 ]…”

“…[ 2 ] A high index of clinical suspicion by primary physician or even by a qualified team of paramedics with knowledge of the third stage of labour is paramount for diagnosis. [ 2 3 4 5 6 7 ] The aim of this case report is to reiterate the occurrence of acute uterine inversion after active management of third stage of labour. Undoubtedly, rapid diagnosis and a multidisciplinary approach plays a big role in preventing maternal mortality.…”

Successful use of condom catheters for management of uterine inversion: Case report and literature review

“… Intrauterine balloon tamponade is used to stop bleeding associated with uterine inversion Haeri et al, 2015 [12] A 38-year-old primigravida Intrauterine and intravaginal dual-catheter balloon tamponade were infused with 400 and 240 mL of saline, respectively. Intrauterine balloon tamponade is useful in cases of uterine inversion Marasinghe et al, 2015 [13] A healthy 26-year-old woman Balloon tamponade connected to a conventional urinary catheter bag with a slow infusion of 40 IU of oxytocin started in 1 l of normal saline to achieve uterine tonicity The use of balloon tamponade would be an excellent choice considering its low cost and non-surgical procedure …”