Pelvic and vaginal packing for intractable venous obstetric haemorrhage: practical tips for the obstetrician (original) (raw)
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Obstetrical & Gynecological Survey, 2018
Importance: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide. Even after emergency peripartum hysterectomy (EPH), bleeding may occur in the setting of acquired coagulopathy. This type of bleeding resistant to clipping, ligating, or suturing could be successfully controlled with a pelvic packing. Objective: This review provides an overview of the different pelvic packing techniques used after the failure of an EPH to control severe PPH. It aims to highlight the outcome of patients after packing, the morbidity and complications of packing, the timing and indications of packing, and finally the optimal duration of packing. Evidence Acquisition: Literature relating to pelvic packing after EPH in a PPH setting was reviewed. Results: Packing techniques can be divided into 2 types: pads or roller gauze and balloon pack. The overall success rate was as high as 78.8% with a mortality rate of 12.5%. No major morbidity related to the pelvic packing was documented. The optimal duration of packing is in the range of 36 to 72 hours. Conclusions: Pelvic packing should be part of the armamentarium available to the obstetrician whenever intractable pelvic hemorrhage is encountered. It is quite simple and quick to perform and requires no special medical materials, the rate of complications is very low, and the success rate is high. Relevance: The pelvic packing should be particularly useful in developing countries where more advanced technologies such as selective arterial embolization are not always available. In developed countries, the pelvic packing may be a valuable temporary measure pending transport to a tertiary care facility. Target Audience: Obstetricians and gynecologists, family physicians. Learning Objectives: After completing this activity, the learner should be better able to identify the situations were pelvic packing could be used as a lifesaving procedure; compare the different techniques of pelvic packing, highlighting the potential advantages and disadvantages of each technique; and evaluate the success rate of the procedure and the potential morbidity. Maternal mortality is a major public health problem worldwide, and postpartum hemorrhage (PPH) is one of the leading causes especially in developing countries. 1,2 Even if some progress has been made in recent decades in the management of PPH with the implantation of a multidisciplinary approach and the application of codified protocols, 3 up to 300 women still die every day from obstetric hemorrhage. 4 All authors, faculty, and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: Haemorrhage is one of the most common complication of any surgery. Haemorrhage can be arterial, venous or capillary ooze. Massive haemorrhage if not timely managed may lead to fatal consequences. There are various medical and surgical methods to control haemorrhage. This study aims to achieve hemostasis with the help of pelvic pressure pack in Obstetric and Gynaecologic surgeries when standard methods are failed and to evaluate efficacy of simple and modified technique of pack preparation.Methods: This is an observational study of 11 cases conducted over a period of 4yrs. This study reports modification of standard packing techniques which overcomes some of its limitations. Here the pack was used in different gynaecologic and Obstetric cases, where intractable haemorrhage was the major problem and standard methods to control haemorrhage had failed. Here a simple foley’s catheter rolled with condom and filled with normal saline was used to prepare a pack and kept over the...
Modified abdominal packing method in “near miss” patients with postpartum hemorrhages
Journal of Turkish Society of Obstetric and Gynecology
PRECIS: Karateke packing method can be used as the last life-saving method in patients with postpartum hemorrhage. Amaç: Postpartum kanama nedeni ile peripartum histerektomi yapılan ancak kanama kontrolü sağlanamayan hastalarda daha etkili bir abdominal packing yöntemi tariflemek. Gereç ve Yöntemler: İstanbul Zeynep Kamil Kadın ve Çocuk Hastalıkları Eğitim ve Araştırma Hastanesi'nde Ocak 2016-Eylül 2017 tarihleri arasında doğum sonu kanama nedeniyle tekrarlayan cerrahi girişim uygulanan 6 pelvik kanamalı olguyu retrospektif, gözlemsel ve tanımlayıcı olarak inceledik. Bulgular: Postpartum kanama nedeniyle kliniğimize refere edilen ve peripartum histerektomi ve hipogastrik arter ligasyonu yapılan; ancak kanama kontrolü sağlanamayan beş olgu ile plasenta perkreata rüptürü nedeniyle hipovolemik şokta olan ve acil histerektomi ve hipogastrik arter ligasyonu yapılan bir olgunun intraabdominal masif kanamalarını kontrol etmek için Karateke usulü packing yapıldı. Tüm hastalarda kanama kontrolü sağlandı. Yönteme bağlı komplikasyon gelişmedi. Sonuç: Sonuç olarak Postpartum kanama nedeniyle peripartum histerektomi yapılan ve sonrasında hayatı tehdit eden diffüz kanamalarda Karateke packing yöntemi uygulanması oldukça kolay, klasik abdominal packing'ten daha etkili, komplikasyonu az ve herşeyden önemlisi hayat kurtaran bir yöntemdir. Anahtar Kelimeler: Abdominal packing, peripartum histerektomi, near miss Objective: To describe a more effective abdominal packing method in patients with disseminated intravascular coagulation following peripartum hysterectomy due to postpartum hemorrhage (PPH). Materials and Methods: The present retrospective and descriptive study was conducted to document six cases with refractory pelvic bleeding who underwent a second surgery for PPH between January 2016 and December 2017 at İstanbul Zeynep Kamil Woman and Children Diseases Training and Research Hospital. Results: Karateke packing was performed to control intra-abdominal massive hemorrhages of five women who were referred to our clinic due to PPH who had undergone peripartum hysterectomy and hypogastric artery ligation but hemostasis could not be provided. In addition, a case of hypovolemic shock due to placenta percreta rupture in a woman who had also undergone an emergency hysterectomy and hypogastric artery ligation, which had failed. Hemostasis was provided in all patients. No method-related complication developed. Conclusion: Karateke packing is a very easy method to perform, it is more effective than the classic abdominal packing technique, with a low complication rate, and most importantly, life-saving in patients undergoing a peripartum hysterectomy due to PPH and thereafter experiencing diffuse hemorrhage.
Control of Postpartum Hemorrhage With Uterine Packing
American journal of obstetrics and gynecology, 1993
1. Am J Obstet Gynecol. 1993 Aug;169(2 Pt 1):317-21; discussion 321-3. Control of postpartum hemorrhage with uterine packing. Maier RC. Department of Obstetrics and Gynecology, University Hospital, Augusta, GA 30901-2629. ...
Uterovaginal packing with rolled gauze in postpartum hemorrhage
MedGenMed : Medscape general medicine, 2004
Management options for postpartum hemorrhage (PPH) include oxytocics, prostaglandins, genital tract exploration, ligation or angiographic embolization of uterine/internal iliac arteries, and hysterectomy. After excluding uterine rupture, genital tract lacerations, and retained placental tissue, efforts are directed toward contracting the uterus by bimanual compression and oxytocics. If these are not successful, one must resort to surgical techniques. At this stage, an alternative option to remember is uterovaginal packing. Easy and quick to perform, it may be used to control bleeding by tamponade effect and stabilize the patient until a surgical procedure is arranged. Uterovaginal packing may sometimes obviate the need for surgery altogether. Two cases, a primary and a secondary PPH, managed recently with uterovaginal packing are reported. Despite concerns about concealed hemorrhage or the development of infection with this intervention, none of these problems were encountered, and ...
To determine the efficacy of uterine packing in management of primary postpartum haemorrhage
2018
BACKGROUND: Primary postpartum haemorrhage has been recognized as a leading etiological factor of maternal mortality and morbidity globally. Uterine packing exerts mechanical pressure on the uterine vascular sinuses and is a quick and safe method of controlling haemorrhage. OBJECTIVE: To determine the efficacy of uterine packing in the management of primary postpartum haemorrhage. MATERIALS AND METHODS: This prospective interventional study was conducted at Gynaecology and Obstetrics department st st of Khyber Teaching Hospital, Peshawar from 1 January 2016 to 31 December 2016. 52 patients were included in study. Inclusion criteria was all women of any age or parity, delivered by any mode of delivery who presented with primary postpartum hemorrhage and were managed with uterine packing. Vital monitoring was done and efficacy was confirmed if bleeding ceased and patient remained haemodynamically stable. Patients were followed for six weeks for any postoperative complication. RESULTS:...
2011
BACKGROUND Post-Partum Haemorrhage (PPH) is one of the five leading causes of maternal death in the developed and developing countries. PPH less than up to 1000 ml is well tolerated by a healthy pregnant woman particularly due to physiological increase in the plasma and the red cell mass during pregnancy. We wanted to determine efficacy of uterovaginal packing and its sequelae in low resource settings. METHODS After ethical committee permission and informed patient consent, a four-year retrospective study was conducted in the department of Obstetrics and Gynaecology of Malda Medical College, West Bengal, India. Total number of vaginal deliveries was 41990 in last four years (2014-2018). Total fifty-three (n-53) cases of primary PPH following vaginal deliveries who were hemodynamically stable after initial resuscitation with crystalloid and blood but unresponsive to bimanual compression and medical therapy were managed with uterovaginal packing for 24 hours. Traumatic PPH, PPH due to retained placental tissue or PPH following caesarean deliveries were excluded. RESULTS Out of fifty-three (53) cases, PPH was arrested in forty-eight (48) cases only five (5) cases required further surgical therapy. Combined utero-ovarian artery ligation (quadruple ligation) was done in one patient, and two patients responded to bilateral internal iliac artery ligation (BIIL) or hypogastric artery ligation (HAL). Two patients needed peri partum hysterectomies they continued to lose blood in spite of all conservative uterus saving methods. CONCLUSIONS Uterovaginal packing is a convenient and effective procedure for controlling intractable PPH if detected and managed promptly, when patient is hemodynamically stable. It is very much effective procedure in low resource setting particularly in rural India. Based on our study 90% of woman responded to utero vaginal roller gauze packing. In life threatening haemorrhage uterine packing will not only halt the blood loss and preserve the uterus but also gives an opportunity to reverse and correct any consumptive coagulopathy. By using the uterine roller packing one would expect the total blood loss to be reduced and blood products are avoided. Every obstetrician must be familiar with this simple method in order to avoid having to perform a hysterectomy and preserving the reproductive capability as well as diminishing the operative morbidity and mortality. Uterovaginal packing is a useful technique for control of post-partum haemorrhage in any set up with low resource setting. It is simple, easy technique requiring less skill which can be taught easily to the trainee residents.