Over-expanded lower uterine segment: a cause of intrauterine balloon tamponade failure

Intrauterine balloon tamponade (IBT) is widely used for treating obstetric hemorrhage. However, only a few reports on IBT failure exist. We report a case of IBT failure caused by an over-expanded lower uterine segment (LUS). A 30-year-old woman with twin pregnancy presented with bleeding after cesarean section. During surgery, uterine atony was observed; however, intravenous administration of oxytocin and ergometrine resolved the condition. Continuous hemorrhage was observed postoperatively, despite the administration of uterotonics and uterine massage. Although IBT was performed, the bleeding persisted, as recognized from the drainage fluid. Enhanced computed tomography revealed that the bleeding spot could not be compressed by the inflated balloon due to the over-expanded LUS. The balloon was removed; uterine artery embolization was required to achieve hemostasis. Our experience indicated that over-expanded LUS could cause IBT failure. If bleeding continues post-IBT replacement and an over-expanded LUS is observed, alternative treatments should be promptly