title: Pelvic packing with vaginal traction for the management of intractable hemorrhage.
abstract: OBJECTIVE
  To present clinical cases examining the effectiveness and safety of pelvic packing with vaginal traction for inhibiting obstetric hemorrhage among women receiving treatment at a public obstetrics and gynecology tertiary care hospital in Mexico.
  
  
  METHODS
  In a retrospective observational descriptive study, eight cases of obstetric hemorrhage treated by pelvic packing with vaginal traction between January 2012 and December 2013 at Hospital de la Mujer, Mexico City, Mexico, were reviewed.
  
  
  RESULTS
  The mean patient age was 28.8±6.8 years. The average blood loss was 4535±897 mL. Uterine atony was the cause of bleeding among six patients: histopathologic examination revealed two cases of placenta accreta, one case of placenta percreta, two cases of uteroplacental apoplexy, and one case of myomatosis. For two patients, placental separation was difficult and required surgical management. The packing technique was effective for all patients. No patients presented with infection or required re-operation for bleeding management. No deaths occurred.
  
  
  CONCLUSIONS
  For management of bleeding among patients with underlying coagulation disorders, pelvic packing can be useful when standard techniques such as hysterectomy, tubal hypogastric ligation, and/or pharmacologic therapy are unsuccessful.
authors.affiliation: Servicio de Ginecología y Obstetricia, Hospital de la Mujer, Secretaría de Salud, Mexico D.F., Mexico.
authors.forename: Leonardo A
authors.initials: LA
authors.lastname: Naranjo-Gutiérrez
authors.affiliation: Servicio de Ginecología y Obstetricia, Hospital de la Mujer, Secretaría de Salud, Mexico D.F., Mexico.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Oliva-Cristerna
authors.affiliation: Servicio de Ginecología y Obstetricia, Hospital de la Mujer, Secretaría de Salud, Mexico D.F., Mexico.
authors.forename: Martha L
authors.initials: ML
authors.lastname: Ramírez-Montiel
authors.affiliation: Área Académica de Medicina, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado de Hidalgo, Pachuca, Mexico. Electronic address: mario_i_ortiz@hotmail.com.
authors.forename: Mario I
authors.initials: MI
authors.lastname: Ortiz
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011247:Pregnancy; D012189:Retrospective Studies; D055815:Young Adult
keywords: Obstetric hemorrhage; Pelvic packing; Surgical technique