Zaplan, R.
Abstract
The combined use of B-lynch suture and Bakri balloons known as “uterine sandwich” has not been extensively reported in literature. Although there are case reports that described its successful use for intractable postpartum haemorrhage and effective future fertility preservation with some reported cases of endomyometritis.7 Its limited case report of pregnancy inspired to share about the outcome of this successful pregnancy after catastrophic PPH complication from previous caesarean section managed with “uterine sandwich” technique. This also impart solution to manage pyometra or endomyometritis as part of the complication in this procedure. A 39-year-old woman, gravida 6, para 4, abortus 1, at 32-week gestation was admitted from emergency with vaginal bleeding and labour pain. She has previous two low segments caesarean section (LSCS) where the last LSCS was complicated with massive PPH controlled with B-lynch suture and Bakri balloon. She received 4 PRBC and admitted in ICU with abdominal drain. This complicated with pyometra and abdominal collections. She underwent suction curettage and insertion of pigtail for intrauterine drainage. Patient responded well with proper antibiotics, anticoagulation, and multidisciplinary co-management with the surgeon, microbiologist and internist. She recovered and discharged in her day 21 post-operative and advised completion of antibiotics for 7 days more. After 3 years of this LSCS, she got pregnant and had her booking visit in Armed Forces Hospital (AFH) at 23 weeks gestation. She was booked for elective repeat LSCS at 36-37 weeks gestation. When she presented in emergency, she was taken for emergency LSCS and delivered to a live baby boy with weight 1905 grams and apgar score of 6,8. Intraoperative findings showed abdominal wall adhesions up to the peritoneum obliterating the lower anterior wall and bladder cannot fully visualized. Uterine contour was still intact with minimal filmy to band adhesions to omentum and upper anterior abdominal wall and patient went home after 4 days.