Use of a large Rusch hydrostatic catheter balloon to control postpartum haemorrhage resulting from a low placental implantation

Lau MSK, Tee JCS
Correspondence: Dr Matthew Lau, mattlau@hotmail.com

ABSTRACT
We describe the successful use of a balloon catheter in primary postpartum haemorrhage secondary to placenta praevia. A 29-year-old woman was admitted for cervical priming at 37 weeks. Antenatal screening ultrasonography showed a normally-sited placenta. During the surgical induction of labour, bleeding per vaginum was noted, and a mass was felt at the cervical os. Emergency caesarean section was performed, and a placenta praevia was confirmed. Upon reversal of general anaesthesia, vaginal bleeding was noted despite a well-contracted uterus. The estimated blood loss was 1,200 ml. A hydrostatic catheter was inserted vaginally into the uterine cavity. After 17 hours, it was removed with no vaginal bleeding. The insertion for the balloon catheter was easy and simple, requiring minimal analgesia, and it was without significant complication. As obstetricians become more confident in this technique, surgical intervention may be avoided. This may subsequently lead to a reduction in maternal morbidity and mortality.

Keywords: low placental implantation, placental praevia, postpartum haemorrhage, pregnancy complication, Rusch hydrostatic catheter
Singapore Med J 2009; 50(9): e321-e323