title: Does uterine gauze packing increase the risk of puerperal morbidity in the management of postpartum hemorrhage during caesarean section: a retrospective cohort study.
abstract: BACKGROUND
  To compare the outcomes especially the puerperal morbidity of uterine gauze packing (UGP) with those of uterine balloon tamponade (UBT) in the management of postpartum hemorrhage (PPH) during caesarean section (c-section).
  
  
  METHODS
  It was considered success as no requirement for either a further therapy or hysterectomy for PPH. The postpartum infection risk was pragmatically measured as puerperal morbidity.
  
  
  RESULTS
  The identified PPH subjects were subdivided into two groups for comparison, in which UGP or UBT was used as second-line therapy for women undergoing c-sections between January 2010 and September 2014. Of the 318 c-section subjects initially treated by basic managements for expected PPH, 99 cases underwent UGP and 66 UBT as the second-line therapies to stop persistent bleeding. The success rates of the UGP and UBT groups were 90.91 and 87.88%, respectively. Only one patient in UBT group resorted to hysterectomy. The respective rates of puerperal morbidity were 10.10 and 13.64%, with risk ratio of 0.74 (95% CI: 0.32, 1.72). There were no significant differences between the two groups even after the adjustment for potential confounding factors.
  
  
  CONCLUSIONS
  UGP appears to be effective in treating PPH during c-section without an observed increase in the risk of potential postpartum infection when compared with UBT. UGP could be recommended as routine for patients who are not responding to conventional basic therapies in addressing PPH, along with the provision of appropriate training.
authors.affiliation: Department of Obstetrics, International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine Shanghai, PR China.
authors.forename: Yu-Na
authors.initials: YN
authors.lastname: Guo
authors.affiliation: Department of Obstetrics, International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine Shanghai, PR China.
authors.forename: Jue
authors.initials: J
authors.lastname: Ma
authors.affiliation: Department of Biostatistics, Shanghai Jiao Tong University School of Medicine 280 South Chongqing Road, Shanghai 200025, PR China.
authors.forename: Xiao-Jin
authors.initials: XJ
authors.lastname: Wang
authors.affiliation: Department of Biostatistics, Shanghai Jiao Tong University School of Medicine 280 South Chongqing Road, Shanghai 200025, PR China.
authors.forename: Bing-Shun
authors.initials: BS
authors.lastname: Wang
keywords: Postpartum hemorrhage; caesarean section; postpartum infection; uterine balloon tamponade; uterine gauze packing