ABSTRACT
After salpingectomy, recurrent ectopic pregnancies occur in the contralateral fallopian tube. Here, we present a case of ipsilateral remnant fallopian tube pregnancy in a 30-year-old woman with a history of incomplete prior operation to remove the middle region of the left fallopian tube following fallopian tube isthmus pregnancy 6 years earlier. During the previous salpingectomy, the left fallopian tube was not completely observed because of adhesions to the pelvic peritoneum and sigmoid colon; a partial remnant may have been present. The patient presented with lower abdominal pain 6 weeks after the most recent menstrual cycle, and transvaginal ultrasonography revealed a remnant left fallopian tube ectopic pregnancy. A 4 cm-sized mass identified at the distal end of the remnant left fallopian tube and the proximal remnant tube were laparoscopically removed. The possibility of an ipsilateral remnant tubal pregnancy should be carefully considered in spontaneous pregnancy after partial fallopian tube resection.
ABSTRACT
Intrauterine globe-shaped metreurynter tamponade has been used for some time to treat massive postpartum hemorrhage (PPH). More recently, the Bakri balloon has come into use to treat PPH. It is made of silicon, possesses a drainage lumen, and has a sausage-like spindle shape. The aim of the present study was to investigate the clinical usefulness of Bakri balloon tamponade for massive PPH. Subjects in the present study comprised 5 patients with uterine atony, 3 with placenta previa, and 2 with low-lying placenta. All patients exhibited massive PPH and resistance to conventional hemostatic managements. Bakri balloon tamponade was appliedto these 10 patients. The mean amounts of uterine bleeding (average ± SD) before and after Bakri insertion were2,732 ± 1,397 mL and 380 ± 376 mL, respectively. The median (third-first quartile ranges) volume of salineinflating the balloon was 200 mL (300-150 mL). The median (third-first quartile ranges) indwelling duration of Bakri balloon was 24 hours (24-11 hrs). The overall success rate of Bakri balloon tamponade was 90% (9/10).There were no cases of slipping out or complications regarding balloon placement. Our findings suggest that Bakri balloon tamponade may be applied to the treatment of massive PPH in uterine atony and placenta previa.The Bakri balloon appears to have the following merits: (1) easy insertion into the uterine cavity and low rate of slipping out, (2) proper conformability to the hemorrhagic area due to its spindle shape, (3) ability to monitor blood loss through the drainage lumen even after insertion.