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SOS Bakri Tamponade BallonFrom: R. Daniel Braun (rd.braun@gmail.com)Fri Apr 8 13:11:27 2005
Interesting case last night. 24 Y/O G4 P3012 at 37 weeks. Has Chronic hypertension ands developed superimposed pre-eclampsia. Prior C/S for breech. Hence taken for repeat C/S. Section progressed without problems except that we weren't totally happy with uterine contractions post delivery but not bleeding. Started on Mag SO4 after delivery. 1 hour later, she had a "Seizure" however no postictal state and BP 70/30 with pulse of 124. HGB 6 was 9 preop. Blood started and US reveals lge amount of Clot? Placenta? ????? in uterus. Platelets now 40 K were 200K prior to C/S Fibrinogen 53 was 250. Taken to OR Suction curettage gets a lot(750-1000cc) of clot and bleeding stops for about 3 minutes. Sharp curette has same result. Has had hemabate and misoprostol and 120 units of pitocin. No evidence of laceration. Evil thoughts of hysterectomy in patient with clotting disorder begin to appear. However, Junior Faculty says "What about the Bakri catheter?" We got one out and tried it. bleeding slows down to mere trickle with none above the balloon. 14 hours later catheter removed and patient continues to do great. Seems to be a great alternative to packing or hyst. Even if she started to bleed again after removal, we would have bought time to clear up her coagulopathy. The link below is to a Powerpoint presentation about it on the U. of Michigan's website. I think it ought to be available to people in case they get in a similar situation In our case, we couldn't have packed the uterus because the cervix wasn't dilated enough. http://www.med.umich.edu/obgyn/resdir/protocols/sosbakri.ppt#256,1,SOS
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R. Daniel Braun
Kinky for Governor
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