Use of packing in obstetric hemorrhage of uterine origin.
OBJECTIVE
To determine the safety and effectiveness of uterine packing to stop hemorrhage in obstetric patients following delivery and pregnancy termination.


METHODS
A review of obstetric records at Children's Hospital of Buffalo in a 9-year period was undertaken. Patients with uterine packing were identified. Indications, additional medical and surgical procedures, estimated blood loss, postoperative complications and packing material used were reviewed.


RESULTS
A total of 9 patients were identified among 34,071. Five patients had hemorrhage during cesarean section. Two patients had hemorrhage after vaginal delivery; 1 case of which had failure with packing and resulted in postpartum hysterectomy. The remaining 2 patients had hemorrhage after dilation and evacuation. Uterine atony unresponsive to oxytocics was the most common indication for uterine packing (44%). The average hematocrit decrease was 10.4% (average total blood loss, 2,200 mL), and all patients received transfusion except 1. The only immediate postoperative complications occurred in a patient with postpartum hysterectomy after failed packing; she developed a pelvic abscess but did well after drainage.


CONCLUSIONS
Uterine packing may be a reasonable alternative to further surgical intervention in patients with intractable obstetric hemorrhage who wish to preserve fertility.
Hsu
Senzan
S
Department of Gynecology and Obstetrics, State University of New York, Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA. hsusz@yahoo.com
Rodgers
Bruce
B
Lele
Amol
A
Yeh
John
J
D000328:Adult; D002585:Cesarean Section; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006489:Hemostatic Techniques; D006801:Humans; D007744:Obstetric Labor Complications / Q000628:therapy; D006473:Postpartum Hemorrhage / Q000175:diagnosis / Q000628:therapy*; D011247:Pregnancy; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014592:Uterine Hemorrhage / Q000175:diagnosis / Q000628:therapy*