Placement of a Bakri balloon in the lower uterine segment effectively controls uterine bleeding in a case of postpartum haemorrhage due to HELLP syndrome complicated by disseminated intravascular coagulation

Abstract

This case report describes the use of the SOS Bakri tamponade balloon (Cook (UK) Limited) in the management of postpartum haemorrhage in a woman suffering from HELLP syndrome and associated disseminated intravascular coagulation (DIC). A 21-year-old nulliparous woman was admitted in established labour at 36 weeks. The delivery was expedited using a ventouse for a non-reassuring CTG. After delivery the woman became hypertensive with the oliguria and proteinuria. A diagnosis of pre-eclampsia with fulminating HELLP syndrome and a consumptive coagulopathy was confirmed by appropriate blood tests. The woman developed both vaginal bleeding and bleeding from venepuncture sights. Treatment included infusion of syntocinon, cryoprecipitate, fresh frozen plasma, platelets and red blood cells. A central venous pressure (CVP) line was sited. Despite these supportive measures the woman's condition did not improve. An examination under regional anaesthesia revealed no evidence of bleeding arising from the lower genital tract and an empty well-contracted uterus. A Bakri balloon was inserted into the upper segment of the uterus with ultrasound imaging but the balloon relocated in the lower uterine segment when inflated. There was, however, effective control of the uterine bleeding and the women's condition improved.