Angiographic findings after vaginal gauze packing: New insight into an old technique

Abstract

We had a transferred case of cervical ectopic pregnancy with hemorrhagic shock at 6 weeks of gestation. Upon arrival at hospital, we performed tight and full vaginal gauze packing to push the uterus upward to control the patient's hemorrhage. Following stabilization of her general condition, she was treated with uterine artery embolization. Using angiography, the effectiveness of vaginal gauze packing for emergency hemostasis by the presumed mechanism of impairing blood flow through the uterine artery was demonstrated. To our knowledge, there are no reports that have previously demonstrated angiographic findings similar to ours after vaginal gauze packing. Vaginal gauze packing is an effective, rapid, and convenient hemostatic procedure able to be carried out in a time-sensitive and challenging situation. As a result, this procedure gives clinicians more time to improve the patients' general status and arrange for transfusion and further definitive treatment.

Cardiac arrest due to massive hemorrhage from uterine adenomyosis with leiomyoma successfully treated with damage control resuscitation

“…It was previously reported that uterine bleeding might occur with adenomyosis, especially when dienogest was administered, as in the present case . The treatment options for uterine bleeding include pharmacological treatment, angiographic embolization, balloon tamponade, gauze packing, and hysterectomy . If the bleeding cannot be controlled using less invasive procedures, hysterectomy is required to achieve definitive hemostasis.…”

Use of Vaginal Packing in the Management of Lower Uterine Segment Atony

“…The mechanism of hemostasis probably depended on two mechanisms: 1) flask lower uterine segments compressed between the well contracted uterine fundus and vaginal packing, and 2) due to impaired blood flow through the uterine artery owing to an elevated uterus. Koyama et al's findings suggested a second mechanism (12). Compressing the uterus may lead to elongated and curved uterine arteries in a vertical direction, a narrowing of intravascular space and obstructing the vessels, and the reduction of uterine blood flow.…”