Introduction: Uterine atony is the most frequent cause of post-partum hemorrhage (PPH). Management may include medical, mechanical, and surgical methods. A commercially available uterine tamponade balloon, the Bakri™ tamponade balloon catheter (Cooper Surgical®) is frequently employed to manage PPH due to uterine atony and reported side effects or complications are generally rare. 
Case presentation: A primigravida developed terminal fetal bradycardia in the setting of suspected placental abruption in the second stage of induced labor. She underwent a low forceps assisted vaginal birth followed by postpartum hemorrhage due to atony, requiring multiple uterotonics and placement of a Bakri™ uterine compression balloon with cessation of hemorrhage. Within an hour of placement, the patient felt and heard a “pop” with significant abdominal pain and hypotension. On examination, abdominal viscus was present in the vagina consistent with uterine rupture. Laparotomy revealed a total uterine rupture requiring hysterectomy.
Conclusion: Bakri™ balloon remains an available tool in management of atony; however, complications may arise.  Clinicians should carefully weigh the potential risks of uterine tamponade balloons against alternative management strategies for uterine atony.