Intrauterine vacuum-induced hemorrhage-control device for hemorrhage after myomectomy: a case report and review of the literature.

Background: The Jada intrauterine vacuum-induced hemorrhage-control device was approved by the United States Food and Drug Administration (FDA) in 2020 and serves as an additional instrument for controlling postpartum hemorrhage. The device utilizes low-level vacuum to induce myometrial contraction, thereby rapidly controlling hemorrhage. The utility of the device for management of postpartum hemorrhage is well-described. However, its use for intraoperative hemorrhage in gynecologic surgery has not yet been reported. Case Description: We present the experience of a 39-year-old patient who presented for heavy vaginal bleeding and a mass protruding from her vagina. Examination in the emergency room (ER) was consistent with a large prolapsing necrotic myoma. She underwent an emergent exam under anesthesia and vaginal myomectomy, after which brisk bleeding was noted from the uterus. Her bleeding was refractory to bimanual massage. An intrauterine vacuum-induced hemorrhage-control device was inserted and bleeding rapidly resolved. The device was removed on post-operative day (POD) #1 and minimal bleeding was noted through the remainder of her post-operative course. The device was successful in treatment of intraoperative hemorrhage after vaginal myomectomy. Application was identical to application for postpartum hemorrhage and the effect was rapid. Conclusions: The Jada was successfully applied in an acute episode of heavy bleeding during management of abnormal uterine bleeding secondary to a large prolapsing necrotic myoma. It may be of interest to formally pursue studies investigating future applications of Jada in controlling other etiologies of abnormal uterine bleeding in gynecologic surgery.