Biomaterial Database

The uterine sandwich for persistent uterine atony: combining the B-Lynch compression suture and an intrauterine Bakri balloon. 2007

Wendy L Nelson, and John M O'Brien

Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY, USA.

OBJECTIVE The objective of the study was to evaluate the effectiveness of a combination of surgical interventions for control of postpartum hemorrhage. METHODS At cesarean delivery, patients with persistent bleeding from uterine atony after the administration of oxytonics were treated with the placement of a B-Lynch suture. When the B-Lynch failed, subsequent placement of an intrauterine Bakri balloon followed. This combination is termed the uterine sandwich. RESULTS The uterine sandwich was successful for all 5 patients undergoing this approach. The median nadir hematocrit was 21.1% (range 20.1% to 28%). The balloon was in place for a median duration of 11 hours (range 10-24 hours). The median volume infused into the balloon was 100 mL (range 60-250 mL). No complications were observed. CONCLUSIONS Placing an intrauterine Bakri balloon in conjunction with the B-Lynch uterine compression suture was successful in treating uterine atony.

UI	MeSH Term	Description	Entries
D010120	Oxytocics	Drugs that stimulate contraction of the myometrium. They are used to induce LABOR, OBSTETRIC at term, to prevent or control postpartum or postabortion hemorrhage, and to assess fetal status in high risk pregnancies. They may also be used alone or with other drugs to induce abortions (ABORTIFACIENTS). Oxytocics used clinically include the neurohypophyseal hormone OXYTOCIN and certain prostaglandins and ergot alkaloids. (From AMA Drug Evaluations, 1994, p1157)	Oxytocic,Oxytocic Agent,Oxytocic Drug,Uterine Stimulant,Uterine Stimulants,Oxytocic Agents,Oxytocic Drugs,Oxytocic Effect,Oxytocic Effects,Agent, Oxytocic,Agents, Oxytocic,Drug, Oxytocic,Drugs, Oxytocic,Effect, Oxytocic,Effects, Oxytocic,Stimulant, Uterine,Stimulants, Uterine
D011247	Pregnancy	The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH.	Gestation,Pregnancies
D005260	Female		Females
D006473	Postpartum Hemorrhage	Excess blood loss from uterine bleeding associated with OBSTETRIC LABOR or CHILDBIRTH. It is defined as blood loss greater than 500 ml or of the amount that adversely affects the maternal physiology, such as BLOOD PRESSURE and HEMATOCRIT. Postpartum hemorrhage is divided into two categories, immediate (within first 24 hours after birth) or delayed (after 24 hours postpartum).	Hemorrhage, Postpartum,Delayed Postpartum Hemorrhage,Immediate Postpartum Hemorrhage,Hemorrhage, Delayed Postpartum,Hemorrhage, Immediate Postpartum,Postpartum Hemorrhage, Delayed,Postpartum Hemorrhage, Immediate
D006488	Hemostasis, Surgical	Control of bleeding during or after surgery.	Surgical Hemostasis,Hemostases, Surgical,Surgical Hemostases
D006489	Hemostatic Techniques	Techniques for controlling bleeding.	Hemostatic Technics,Hemostatic Technic,Hemostatic Technique,Technic, Hemostatic,Technics, Hemostatic,Technique, Hemostatic,Techniques, Hemostatic
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D013536	Suture Techniques	Techniques for securing together the edges of a wound, with loops of thread or similar materials (SUTURES).	Suture Technics,Suture Technic,Suture Technique,Technic, Suture,Technics, Suture,Technique, Suture,Techniques, Suture
D014593	Uterine Inertia	Failure of the UTERUS to contract with normal strength, duration, and intervals during childbirth (LABOR, OBSTETRIC). It is also called uterine atony.	Uterine Atony,Atony, Uterine,Inertia, Uterine