Abdomino‐pelvic packing revisited: An often forgotten technique for managing intractable venous obstetric haemorrhage

Abstract

Postpartum haemorrhage (PPH) remains the leading cause of maternal mortality worldwide, contributing to more than two-thirds of peripartum deaths, especially in developing countries. 1 This obstetric emergency requires timely recognition and management, as the overwhelming majority of deaths due to uncontrolled PPH occur within four hours of delivery. Surgical interventions such as intrauterine balloon tamponade, 2 compression sutures 3,4 and selective devascularisation (including internal iliac artery Background: Surgical packing should not be seen as a 'bail out' for the less skilled obstetrician who is unable to control obstetric haemorrhage using conventional techniques. Rather, this should be considered in cases of coagulopathy or where haemorrhage persists from raw surfaces, venous plexuses and inaccessible areas. Materials and methods: Data from seven women who underwent abdominopelvic packing for intractable postpartum bleeding were collected. The primary outcome was success of intra-abdominal packing and secondary outcomes included estimated blood loss, units transfused, length of stay and postoperative complications.Results: All seven women (median age 39 years, interquartile range (IQR) 3.25) had caesarean section deliveries with median estimated blood loss of 5521.4 mL (IQR 4475) and median of 6.9 (IQR 4.75) units transfused. Abdomino-pelvic packing was successful in all cases including in three women who had continued bleeding after peripartum hysterectomy. In the remaining four, bleeding stopped with packing, enabling the uterus to be conserved. The median number of packs inserted was 6.1 (IQR 4.2) and median shock index at time of decision to pack was 0.98 (IQR 0.13). The median pack dwell time was 30.8 h (IQR 24), while median length of stay following removal was 48 h (IQR 2.14). Conclusion:Intractable bleeding in these seven cases was successfully controlled by abdomino-pelvic packing, allowing supportive correction of hypothermia, tissue acidosis, coagulopathy and hypovolemia. The technique of packing is an essential skill in managing massive obstetric haemorrhage, in addition to uterine balloon tamponade, compression sutures and peripartum hysterectomy. K E Y W O R D S coagulopathy, obstetric hysterectomy, packing, postpartum haemorrhage

Intra-Abdominal Gauze Packing for Uncontrolled Hemorrhage in Non-Trauma Patients

“…In the current study, gauze packing was a very useful method of controlling paravertebral venous plexus bleeding (Figure 3) and retroperitoneal vein bleeding [12]. In obstetrics, intrauterine gauze or abdominopelvic gauze packing is a lifesaving method for controlling postpartum bleeding [13][14][15].…”

Damage-Control Surgery for Maternal Near-Miss Cases of Placenta Previa and Placenta Accreta Spectrum

“…For example, a UK hospital cohort of seven patients who underwent abdominopelvic packing for intractable postpartum bleeding over a 9-year period included two with PAS. 14 A French questionnaire study included 25 participating centers who submitted data on their experience with 53 cases of abdominal packing for PPH, comprising one through 7 cases at each center over a 10-year period. 17 Hemorrhage was associated with PAS in 12 cases.…”

Pelvic gauze packing combined with an external fixator for the treatment of unstable pelvic fractures with a huge retroperitoneal hematoma: a case report

“…This is because larger gauzes have a wide compression area, allow for a short operation time, and have a good hemostatic effect. Furthermore, due to the larger size, they are easy for en bloc removal and hard to miss; (II) packing an appropriate number of gauzes according to the extraperitoneal space: excessive packing increases the pressure in the abdominal cavity, leading to abdominal compartment syndrome (9). On the other hand, insufficient packing does not achieve a satisfactory hemostatic effect.…”