Conservative management of a recurrent puerperal uterine inversion with bakri^® balloon tamponade

Jesús Joaquín Hijona Elósegui, Francisco Javier Frutos Arenas, Antonio Carballo García, Juan Antonio López López, Gabriel Castilla Peinado Peinado, Juan Manuel Torres Martí
DOI: 10.4236/ojog.2011.14038                

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.

Keywords

Balloon Tamponade; Intrauterine; Management; Postpartum Haemorrhage; Uterine Inversion; Review; Treatment

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Morini, A., Angelini, R. and Giardini, G. (1994) Acute puerperal uterine inversion: A report of 3 cases and an analysis of 358 cases in the literature. Minerva Ginecologica, 46, 115-127.
[2]	Siva, A., Zarina, M. and Mukudan, K. (2006) Puerperal uterine inversion: A report of four cases. Journal of Obstetrics and Gynaecology Research, 32, 341-345. doi:10.1111/j.1447-0756.2006.00407.x
[3]	Das, P. (1940) Inversion of the uterus. British Journal of Obstetrics and Gynaecology, 47, 525-548. doi:10.1111/j.1471-0528.1940.tb08843.x
[4]	Van Vugt, P.J., Baudoin, P., Blom, V.M. and Van Deursen, C.T. (1981) Inversio uteri puerperalis. Acta Obstetricia et Gynecologica Scandinavica, 60, 353-362. doi:10.3109/00016348109154123
[5]	Milenkovic, M. and Khan, J. (2005) Inversion of the uterus: A serious complication at childbirth. Acta Obstetricia et Gynecologica Scandinavica, 84, 95-106. doi:10.1111/j.0001-6349.2005.0254b.x
[6]	Simó, M., Penalva, G. and Domingo, X. (1992) Inversión uterina obstétrica: Caso clínico y revisión del tema. Acta Ginecológica, 49, 141-143.
[7]	O’Connor, C.M. (1977) Recurrent postpartum uterine inversion. British Journal of Obstetrics Gynaecology, 84, 789-790. doi:10.1111/j.1471-0528.1977.tb12494.x
[8]	Bell, J.E. Jr., Wilson, G.F. and Wilson, L.A. (1953) Puerperal inversion of the uterus. American Journal of Obstettics Gynecology, 66, 767-780.
[9]	Mehra, U. and Ostapowicz, F. (1976) Acute puerperal inversion of the uterus in a primipara. Obstetrics and Gynecology, 47, 30-32.
[10]	Baskett, T.F. (2002) Acute uterine inversion. Review of 40 cases. Journal of Obstetrics and Gynaecology Canada, 24, 953-956.
[11]	Vavilis, D., Tsolakidis, D., Goutzioulis, A.D. and Bontis, J.N. (2008) Complete uterine inversion during caesarean. Cases Journal, 1, 127. doi:10.1186/1757-1626-1-127
[12]	Hostetler, D.R. and Bosworth, M.F. (2000) Uterine Inversion. A life-theatening Obstetric emergency. Journal of the American Board of Family Practice, 3, 120-123.
[13]	Parikshit, D.T. and Niranjan, M.M. (2004) Pregnancy outcome after operative correction of puerperal uterine inversion. Archives of Gynecology and Obstetrics, 69, 214-216. doi:10.1007/s00404-002-0425-1
[14]	Díaz, E., Paniagua, P., Segovia, O., Herrero, E., Díez Gómez, E. and Guerra, J.M. (1994) Inversión uterina puerperal: Caso clínico. Revisión de la literatura. Toko-Gin Pract, 53, 313-316.
[15]	Mohanty, A.K. and Trehan, A.K. (1998) Puerperal uterine inversion: Analysis of three cases managed by repositioning, and literature review. Journal of Obstetrics Gynaecology, 18, 353-354. doi:10.1080/01443619867119
[16]	Soleymani Majd, H., Pilsniak, A. and Reginald, P. (2009) Recurrent uterine inversion: A novel treatment approach using SOS Bakri balloon. British Journal of Obstetrics and Gynaecology, 116, 999-1001. doi:10.1111/j.1471-0528.2009.02165.x
[17]	Beringer, R.M. and Patteril, M. (2004) Puerperal uterine inversion and shock. British Journal of Anaesthesia, 92, 439-441. doi:10.1093/bja/aeh063
[18]	Gross, R.C. and McGahan, J.I. (2009) Sonographic detection of partial uterine inversion. American Journal of Roentgenology, 144, 761.
[19]	Ripley, D.L. (1999) Uterine emergencies. Atony, inversion, and rupture. Obstetrics and Gynecology Clinics of North America, 26, 419. doi:10.1016/S0889-8545(05)70087-5
[20]	Takeda, A., Manabe, S., Mitsui, T. and Nakamura, H. (2006) Management of patients with ectopic pregnancy with massive hemoperitoneum by laparoscopic surgery with intraoperative autologous blood transfusion. Journal of Minimally Invasive Gynecology, 13, 43-48. doi:10.1016/j.jmig.2005.09.100
[21]	Abouleish, E., Ali, V., Joumaa, B., López, M. and Gupta, D. (1995) Anaesthetic management of acute puerperal uterine inversion. British Journal of Anaesthesia, 75, 486-487.
[22]	Calder, A.A. (2000) Emergencies in operative obstetrics. Best Practice and Research Clinical Obstetrics and Gynaecology, 14, 43-55. doi:10.1053/beog.1999.0062
[23]	Vijayaraghavan, R. and Sujatha, Y. (2006) Acute postpartum uterine inversion with haemorrhagic shock: Laparoscopic reduction: A new method of management? British Journal of Obstetrics and Gynaecology, 113, 1100-1102. doi:10.1111/j.1471-0528.2006.01052.x
[24]	Sumera, T., Mahmood, A. and Samina, A. (2003) Indication and maternal outcome of emergency peripartum hysterectomy. Pakistan Journal of Medical Sciences, 19, 182-186.
[25]	Vitthala, S., Tsoumpou, I., Anjum, Z.K. and Aziz, N.A. (2009) Use of bakri balloon in post-partum haemorrhage: A series of 15 cases. The Australian and New Zealand Journal of Obstetrics and Gynaecology, 49, 91-94. doi:10.1111/j.1479-828X.2009.00968.x