Video image: Ultrasound findings of a novel subtype of atonic postpartum hemorrhage: is it still a diagnosis of exclusion?

CT scan assessment of intrauterine balloon tamponade failure for the treatment of atonic postpartum haemorrhage: implications for treatment

“…Recently, more and more facilities are managing severe PPH with emergency physicians, resulting in a gradual increase in the number of facilities performing CT scans. In severe atonic PPH, bleeding is thought to originate from the entire placental detachment plane; however, analysis of refractory atonic PPH using dCT or ultrasonography has shown that there is usually a single point of bleeding in the arterial phase, even in the presence of good uterine contractions 6,10–12 . In our analysis of refractory atonic PPH, no cases required arterial embolisation or hysterectomy in the absence of contrast extravasation in the arterial phase of dCT 11 .…”

Novel intrauterine balloon tamponade systems for postpartum hemorrhage

“…Half of PRACE cases require transarterial embolization . In these reports, we revealed the underlying cause of IBT failure . In cases with arterial bleeding from the lower uterine cavity, balloon displacement is the primary cause of the failure.…”

“…We previously reported a novel subtype of atonic PPH, which we call “PRACE”, characterized by PPH, Resistance to treatment, and Arterial Contrast Extravasation on dynamic computed tomography (CT) scans . Half of PRACE cases require transarterial embolization .…”

“…This is probably because the bleeding site is almost always around the boundary between the upper and the lower uterine cavity, and balloon displacement fails to exert firm and direct pressure onto the bleeding site. As for the cases with arterial bleeding from the upper uterine cavity, there is much reason to assume that IBT failure is mostly attributed to technical difficulties in placing the balloon into the upper uterine cavity . The narrow channel at the level of the internal orifice hampers balloon insertion .…”

“…As for the cases with arterial bleeding from the upper uterine cavity, there is much reason to assume that IBT failure is mostly attributed to technical difficulties in placing the balloon into the upper uterine cavity. 4,5 The narrow channel at the level of the internal orifice hampers balloon insertion. 4 Should the balloon be placed into the upper uterine cavity, the balloon is usually expelled toward the lower uterine cavity due to strong contraction of the thick upper myometrium.…”