Video image: Matsubara’s Nelaton and Fishing methods for easier Bakri balloon insertion and avoiding its prolapse during cesarean section

Various intrauterine hemostatic balloons for postpartum hemorrhage (PPH) have been developed. Among them, the Bakri balloon has been widely used for PPH after vaginal delivery and cesarean section (CS).1) This balloon is considered “easy to handle” and serves as a preventive treatment for PPH as “insurance,” which explains why its use has spread. While attempting to use it in many patients, we noted that the Bakri balloon is sometimes not so easy to handle. The obstacles hindering a smooth procedure, and thus effective hemostasis, are 1) the occasional difficulties in achieving smooth insertion of the balloon, and 2) the difficulties in keeping the balloon intrauterine, such that the balloon sometimes prolapses into the vagina. We developed several methods to overcome these problems,2–6) of which “holding the uterine cervix” (Matsubara-Takahashi [MT] holding)3) has already been explained in a video article2) of this journal. Here, we introduce two other useful procedures: the Nelaton (Matsubara)4) and Fishing (Matsubara) methods,5) both of which will enable obstetricians to handle easily the Bakri balloon during CS.