Intrauterine, Vacuum-Induced, Hemorrhage-Control Device System Contributing to Blood Loss in Fulminant DIC.

Abstract

Background: Postpartum hemorrhage (PPH) complicates 3%-5% of deliveries. Uterine atony is the most common cause of PPH, and there are several interventions that can be used to improve atony, including uterine massage, uterotonics, and intrauterine balloons. The intrauterine vacuum-induced hemorrhage-control device is a suction device that is placed in the lower uterine segment, which creates negative pressure on the myometrium to induce myometrial contraction. Case: The patient was a 37-year-old G3P1011 female with chronic hypertension who presented for induction of labor at term. Spontaneous rupture of membranes occurred several hours later with simultaneous placental abruption leading to DIC. Urgent cesarean section was performed for fetal distress remote from delivery. Massive transfusion protocol was initiated, and an intrauterine vacuum-induced hemorrhage-control device was placed intravaginally in an attempt to control blood loss. However, rather than acting as a tamponade, the device appeared to draw out a great blood loss with its suction. The patient underwent bilateral uterine artery embolization, and the device was replaced with an intrauterine balloon. Patient was transferred to the ICU, and blood products were transfused until the patient was stabilized. Conclusion: While a preliminary study appeared to show the safety and efficacy of the intrauterine vacuum-induced hemorrhage-control device, its use was limited to uterine hemorrhage secondary to uterine atony. It should be avoided in cases of hemorrhage where coagulopathy is suspected.