A thrombogenic uterine pack for postpartum hemorrhage.
BACKGROUND
A low-lying placenta or placenta previa is frequently associated with postpartum hemorrhage from a low implantation site. We describe the successful use of a thrombin-soaked uterine pack for this condition.


METHODS
A 30-year-old woman, gravida 3, para 0-0-2-0, had placenta previa diagnosed by ultrasound at 26 weeks' gestation. A repeat examination at 35 weeks demonstrated a low-lying placenta. The patient had an uncomplicated intrapartum course and was delivered by vacuum extraction, but excessive vaginal bleeding was noted 3 hours after spontaneous delivery of the placenta. Oxytocin, prostaglandin, and uterine curettage failed to control the hemorrhage. In an attempt to avoid laparotomy, we placed a thrombin-soaked uterine pack over the bleeding site. There was minimal vaginal bleeding during the following 8 hours, so the pack was removed. The patient had no further complications and was released 3 days after delivery.


CONCLUSIONS
A thrombin-soaked uterine pack may successfully control lower uterine segment bleeding following delivery of a patient with a low-lying placenta. This technique offers the obstetrician another treatment option in selected cases of postpartum hemorrhage.
Bobrowski
R A
RA
Department of Obstetrics and Gynecology, Wayne State University/Hutzel Hospital, Detroit, Michigan, USA.
Jones
T B
TB
D000287:Administration, Topical; D000328:Adult; D005260:Female; D006801:Humans; D007744:Obstetric Labor Complications / Q000188:drug therapy; D010121:Oxytocin / Q000627:therapeutic use; D010923:Placenta Previa / Q000150:complications* / Q000000981:diagnostic imaging; D006473:Postpartum Hemorrhage / Q000209:etiology* / Q000628:therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D011453:Prostaglandins / Q000627:therapeutic use; D013630:Tampons, Surgical; D013917:Thrombin / Q000008:administration & dosage*; D016216:Ultrasonography, Prenatal; D014592:Uterine Hemorrhage / Q000188:drug therapy
D011453:Prostaglandins; D010121:Oxytocin; D013917:Thrombin