title: Nonpneumatic antishock garment combined with bakri balloon as a nonoperative "uterine sandwich" for temporization of massive postpartum hemorrhage from disseminated intravascular coagulation.
abstract: Disseminated intravascular coagulation (DIC) is an uncommon but potentially catastrophic complication of postpartum hemorrhage. We describe two cases of massive postpartum hemorrhage complicated by DIC that were successfully temporized with combined use of the Bakri balloon and nonpneumatic antishock garment (NASG) during massive transfusion. In the first case, a healthy, term gravida underwent emergent cesarean for fetal bradycardia during labor induction. 10 minutes after completion of surgery, brisk vaginal hemorrhage of nonclotting blood from fulminant DIC resulted in maternal shock. A Bakri balloon and NASG were placed during massive transfusion, resulting in rapid maternal stabilization. In the second case, a healthy, term gravida suffered an amniotic fluid embolism during labor requiring emergent cesarean delivery and complicated by cardiac arrest with successful resuscitation. Postoperative rapid uterine bleeding from DIC was treated with a Bakri balloon and NASG, stabilizing the patient during massive transfusion. Neither patient required further surgical procedures. NASG combined with Bakri balloon may serve as a valuable nonoperative treatment or temporization option in cases of massive postpartum hemorrhage complicated by coagulopathy such as these. Further study of the utility of NASG in high-resource settings is warranted.
authors: Santa Clara Valley Medical Center, Department of Obstetrics and Gynecology, San Jose, CA 95128, USA.
authors: Andrea
authors: 0000-0002-7745-5551
authors: A
authors: Jelks
authors: Santa Clara Valley Medical Center, Department of Obstetrics and Gynecology, San Jose, CA 95128, USA.
authors: Monica
authors: M
authors: Berletti
authors: Santa Clara Valley Medical Center, Department of Obstetrics and Gynecology, San Jose, CA 95128, USA.
authors: Liliana
authors: L
authors: Hamlett
authors: Santa Clara Valley Medical Center, Department of Obstetrics and Gynecology, San Jose, CA 95128, USA.
authors: Michele
authors: M
authors: Hugin
references: Obstet Gynecol. 2006 Oct;108(4):1039-47
references: 17012482
references: Am J Obstet Gynecol. 2011 May;204(5):409.e1-5
references: 21439543
references: BJOG. 2002 Dec;109(12):1377-84
references: 12504974
references: J Obstet Gynaecol Can. 2012 Apr;34(4):341-7
references: 22472333
references: ISRN Obstet Gynecol. 2011;2011:179349
references: 21845226
references: Best Pract Res Clin Obstet Gynaecol. 2008 Dec;22(6):1057-74
references: 18805742
references: Acta Obstet Gynecol Scand. 2012 Jan;91(1):147-51
references: 21501126
references: Am J Obstet Gynecol. 2012 Jan;206(1):65.e1-4
references: 22000893
references: BMC Pregnancy Childbirth. 2013 Nov 15;13:208
references: 24237656