title: The uterine sandwich for persistent uterine atony: combining the B-Lynch compression suture and an intrauterine Bakri balloon.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY, USA.
authors.forename: Wendy L
authors.initials: WL
authors.lastname: Nelson
authors.forename: John M
authors.initials: JM
authors.lastname: O'Brien
mesh_terms: D005260:Female; D006488:Hemostasis, Surgical; D006489:Hemostatic Techniques; D006801:Humans; D010120:Oxytocics / Q000627:therapeutic use; D006473:Postpartum Hemorrhage / Q000209:etiology / Q000601:surgery*; D011247:Pregnancy; D013536:Suture Techniques; D014593:Uterine Inertia / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*
chemical_list: D010120:Oxytocics