Practical consideration of inserting intrauterine balloon during cesarean section for placenta previa

摘要

I read the article by Gronvall et al. (1) regarding Bakri balloon tamponade and the letter from Nesbitt et al. (2) concerning this article. High overall success rates for hemostasis, 86% (1) and 93% (2), respectively, may require some contrivances for the insertion of the balloon, especially in cases of placenta previa; however, both reports did not touch on this. I wish to comment which route, abdominal or vaginal, may be better when inserting the catheter during cesarean section for placenta previa and also wish to describe some practical measures that I usually use.Figure 1 shows some measures for the smooth insertion of the catheter during cesarean section for placenta previa via the abdominal route; (i) tying the two vaginal side ends of a Bakri catheter with thread, (ii) dilating the cervix, (iii) inserting its vaginal side ends toward the vagina via cesarean incision, (iv) with an assistant pulling it, (v) confirming the balloon location at an appropriate site through the uterine incision, (vi) inflating the balloon with 50-100 mL solution, (vii) closing the uterine incision, and finally (viii) further inflating the balloon.