Bakri postpartum balloon: an obstetrician’s armamentarium in managing post-partum haemorrhage

Background: Post-partum haemorrhage (PPH), an obstetric emergency that can complicate vaginal or cesarean deliveries and associated with serious complications. Guidelines for the management of PPH involve a stepwise escalation of pharmacological and eventual surgical approaches. In women who do not respond to uterotonics or medical treatment, a variety of procedures, such as arterial embolization, surgical ligation of the uterine arteries or obstetric hysterectomy, may be used. The Bakri balloon is an intrauterine device indicated to reduce or control PPH temporarily when conservative treatment is warranted. Here, we are presenting case series of primary atonic PPH and which were managed by Bakri Balloon Tamponade (BBT).Methods: This case series included five women with PPH managed by Bakri balloon as a conservative therapeutic option.Results: All five women were in age group between 23 years to 34 years. The causes of PPH were uterine atony, retained placenta and central placenta previa. The Bakri balloon was successful in controlling hemorrhage in all women (five of five) who did not respond to medical uterotonic treatment.Conclusions: Bakri balloon is a simple, easy to use and effective method for conservative management of acute PPH. This device reduces bleeding, shortens the hospital stay and avoids the need for more aggressive procedures.

Broad ligament ectopic pregnancy: a dilemma to diagnose

Broad ligament ectopic pregnancy is a rare and serious form of extrauterine pregnancy with a high risk of maternal mortality. There are no specific clinical features. Ultrasonography may help in diagnosis, but definitive diagnosis is made only during surgery. Authors are reporting a case of 30 years female G3P1L1A1 seven weeks pregnancy with previous lower segment cesarean section and previous history of right sided salpingectomy with no complaints. Ultrasound was advised to know the location of sac this time, in which, she was diagnosed as a case right sided unruptured live ovarian ectopic pregnancy. On examination, signs and symptoms of ectopic pregnancy were absent. On laparoscopy, she was diagnosed as a case of right sided live unruptured broad ligament ectopic pregnancy as her right ovary was absent because of previous surgery.  With advances in sonography and laparoscopic skills, more cases can be diagnosed in the first trimester and can be safely managed laparoscopically.