Maternal outcome after abdominal packing for uncontrolled postpartum hemorrhage despite peripartum hysterectomy

Deffieux, X.; Vinchant, Marie; Wigniolle, Ingrid; Goffinet, François; Sentilhes, Loïc

doi:10.1371/journal.pone.0177092

Cited by 19 publications

(15 citation statements)

References 26 publications

(25 reference statements)

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“…Rather, this remains a crucial skill, which complements the other surgical skills essential when managing massive peripartum bleeding as is evidenced by the fact that one in 14 cases in a recent series of 718 peripartum hysterectomies required further packing for intractable bleeding. 9 Lastly, we agree with the authors' comment that accoucheur experience is important when making the decision whether or not to initiate packing; what is equally important is that the clinician resists the temptation to place further sutures when coagulopathy has evolved or where haemorrhage persists from large raw surfaces, venous plexuses and inaccessible areas, as such aggressive surgery is likely to provoke further bleeding.…”

Section: Dear Editorsupporting

confidence: 52%

Response to Letter to Editor ‘Additional procedures for pelvic gauze packing for obstetric haemorrhage’

Govind

Yoong

2019

Aust NZ J Obst Gynaeco

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We would like to thank Drs Matsubara, Usui and Sakuma for sharing their practice of using a single long Iodoform gauze containing an antibacterial agent (triiodomethane) for pelvic packing as this may reduce the risk of sepsis as well as of miscounting swabs. 1 The authors state that iodine has a broad antimicrobial spectrum with no tendency to produce bacterial resistance.Although they speculate that the iodine-impregnated gauze may reduce infection, this is not proven and most clinicians will still cover these women with broad-spectrum antibiotics. However, we are concerned about the risk of iodine toxicity, which may not be as rare as suggested by the authors. Our literature search [2][3][4][5] indicates that iodine toxicity is related to the amount of iodine absorbed, which in turn is dependent on the concentration of the solution, duration of contact and the route of administration: the longer sheet of Iodoform gauze in contact with a large surface of peritoneum and bowel may allow significant uptake as iodine is more easily absorbed through mucosa compared to skin.Furthermore, the temporary acute renal failure which often follows significant obstetric haemorrhage can impair iodine excretion through the kidneys and plasma levels should be monitored in these patients.Our preference is to use 30 × 30 cm swabs because these are freely accessible in most labour ward theatres. All our cases had received routine intravenous antibiotic cover at induction prior to the caesarean sections, and our practice is to continue this until the packs are retrieved. We are aware of the risk of miscounting, and our theatre team maintains a strict surgical checklist, handover and counting disciplines which mitigate against retained swabs. In the stressful environment that accompanies massive haemorrhage scenarios, we are conscious of the importance of distractions 6 and will especially create a 'sterile cockpit' environment 7 during which the critical phase of swab and instrument counting are not disturbed.We acknowledge that one of the advantages to Drs Matsubara, Usui and Sakuma's suggestion of using a long single swab is that in cases of packing following obstetric hysterectomy, the tail of the gauze strip can be introduced through a partially closed vault into the vagina (as per the Logothetopulos technique 8 ) and the pack subsequently removed by traction via this route, thus obviating a econd laparotomy.Abdomino-pelvic packing should no longer be laughingly dismissed as a 'bail-out' technique for the less skilled obstetric surgeon. Rather, this remains a crucial skill, which complements the other surgical skills essential when managing massive peripartum bleeding as is evidenced by the fact that one in 14 cases in a recent series of 718 peripartum hysterectomies required further packing for intractable bleeding. 9Lastly, we agree with the authors' comment that accoucheur experience is important when making the decision whether or not to initiate packing; what is equally important is that the clinician resists the temptation...

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Section: Dear Editorsupporting

confidence: 52%

Response to Letter to Editor ‘Additional procedures for pelvic gauze packing for obstetric haemorrhage’

Govind

Yoong

2019

Aust NZ J Obst Gynaeco

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“…Thus, mechanical pressure applied to bleeding foci can be increased without having to perform relaparotomy to increase the number of sponges. Deffieux et al ( 15 ) reported the success rate of abdominal packing as 62% in their study. Packing failed in 38% of cases and death occurred in 13 ( 16 ) .…”

Section: Discussionmentioning

confidence: 86%

“…If the sponges are not squeezed sufficiently, bleeding may continue and packing may result in failure. In the study performed by Deffieux et al, ( 15 ) the authors failed to determine the required number of pads in a successful packing treatment. In Karateke packing, the compression strength exerted on the area of bleeding can be increased with the same number of sponges by increasing the traction force and volume of the intra-abdominal balloon.…”

Section: Discussionmentioning

confidence: 99%

Modified abdominal packing method in “near miss” patients with postpartum hemorrhages

Kılıççı

Polat

Küçükbaş

et al. 2018

tjod

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Objective:To describe a more effective abdominal packing method in patients with disseminated intravascular coagulation following peripartum hysterectomy due to postpartum hemorrhage (PPH).Materials and Methods:The present retrospective and descriptive study was conducted to document six cases with refractory pelvic bleeding who underwent a second surgery for PPH between January 2016 and December 2017 at İstanbul Zeynep Kamil Woman and Children Diseases Training and Research Hospital.Results:Karateke packing was performed to control intra-abdominal massive hemorrhages of five women who were referred to our clinic due to PPH who had undergone peripartum hysterectomy and hypogastric artery ligation but hemostasis could not be provided. In addition, a case of hypovolemic shock due to placenta percreta rupture in a woman who had also undergone an emergency hysterectomy and hypogastric artery ligation, which had failed. Hemostasis was provided in all patients. No method-related complication developed.Conclusion:Karateke packing is a very easy method to perform, it is more effective than the classic abdominal packing technique, with a low complication rate, and most importantly, life-saving in patients undergoing a peripartum hysterectomy due to PPH and thereafter experiencing diffuse hemorrhage.

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“…Deffieux et al evaluated the use of intra-abdominal packing for uncontrollable persistent bleeding after peripartum hysterectomy. They found that abdominal packing, used for duration of 24 to 48 hours, is a good option for patient with life-threatening postpartum bleeding after hysterectomy [ 30 ]. A study conducted at China among patients with MAP with high-intensity focused ultrasound (HIFU) and uterine artery embolization (UAE) for retained placenta accreta [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Peripartum Hysterectomy in a Tertiary Care Unit and Its Effect on Patients’ Long-Term Physical and Mental Wellbeing: Quest Is Not Over When You Save the Life

Pathiraja

Jayawardane

2021

Obstetrics and Gynecology International

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Objectives. Peripartum hysterectomy can be performed as an elective procedure or as a life-saving emergency procedure in obstetrics. It is associated with significant maternal morbidity and mortality. We report peripartum hysterectomies done during the study period in a tertiary referral centre, Colombo, Sri Lanka. Methodology. We collected data on all severe acute maternal morbidity and mortality events (SAMM) from June 01, 2014, to June 01, 2015, at De Soysa Hospital for Women (DSHW). We invited all women who underwent PPH to complete the 36-Item Short Form Health Survey questionnaire (SF-36) before hospital discharge and at six months after the hysterectomy date to assess their general and mental health before and after surgery. Focus group discussions (FGD) were used to further evaluate the patient experience and to identify service delivery improvements. Results. There were eleven peripartum hysterectomies done during the study period for 7160 deliveries. None were primigravida. Median age and gestation were 36 years and 37 weeks, respectively. The commonest indication for peripartum hysterectomy was a morbidly adherent placenta (seven). Nine of the deliveries were elective lower-segment caesarean section and two were vaginal deliveries. Four emergency peripartum hysterectomies were done for primary postpartum haemorrhage (PPH) and two for secondary PPH. All patients required intensive care and there were no maternal deaths. The analysis of SF-36 data revealed that all patients suffered a significant reduction in the quality of life at six months after the surgery. FGD highlighted that most patients needed further counselling and support to improve their physical, psychological, and social wellbeing. Some of the patients were willing to share their experience on voluntary basis to help those undergoing peripartum hysterectomies in the future. Conclusion. Peripartum hysterectomy is an important life-saving procedure associated with severe maternal morbidity and mortality. This study reveals that the physical, psychological, and social adverse effects would remain in the long term.

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Maternal outcome after abdominal packing for uncontrolled postpartum hemorrhage despite peripartum hysterectomy

Cited by 19 publications

References 26 publications

Response to Letter to Editor ‘Additional procedures for pelvic gauze packing for obstetric haemorrhage’

Response to Letter to Editor ‘Additional procedures for pelvic gauze packing for obstetric haemorrhage’

Modified abdominal packing method in “near miss” patients with postpartum hemorrhages

Evaluation of Peripartum Hysterectomy in a Tertiary Care Unit and Its Effect on Patients’ Long-Term Physical and Mental Wellbeing: Quest Is Not Over When You Save the Life

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