Re: SOS Bakri Tamponade Ballon
From: art fougner, md (evsono@pipeline.com)
Fri Apr 8 14:14:53 2005
Great! How about a Report for The Female Patient or Contemporary Ob-Gyn?
Art
At Fri, 8 Apr 2005, R. Daniel Braun wrote:
>
>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
>
>--
>R. Daniel Braun
> Kinky for Governor
>
--
art fougner, md
"If you don't know where you are going, you will wind up somewhere else."
Lawrence Peter Berra
