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Pelvic Umbrella Pack for Refractory Obstetric Hemorrhage Secondary to Posterior Uterine Rupture

Howard, Rebecca J.; Straughn, J. Michael Jr MD; Huh, Warner K. MD; Rouse, Dwight J. MD

Case Reports

BACKGROUND: Pelvic hemorrhage continues to be a serious complication of pregnancy and can lead to significant maternal morbidity. The pelvic umbrella pack is a useful alternative to control pelvic bleeding when standard measures fail.

CASE: A patient with a previous low transverse cesarean delivery presented in active labor at term. After anuneventful vaginal delivery, defects in the posterior vaginal wall and lower uterine segment were identified. A hysterectomy with repair of the vaginal laceration was performed, but diffuse bleeding persisted. After routine surgical techniques failed to achieve adequate hemostasis, a pelvic umbrella pack was successfully used to tamponade pelvic bleeding.

CONCLUSION: In the event of continued hemorrhage after hysterectomy, bleeding that is uncontrolled by surgical intervention may be controlled with a pelvic umbrella pack.

The use of a pelvic umbrella pack can be lifesaving in the event of refractory obstetric hemorrhage.

Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama

Address reprint requests to: J. Michael Straughn, Jr, MD, University of Alabama at Birmingham, Division of Gynecologic Oncology, 619 South 19th Street, OHB Room 538, Birmingham, AL 35249; E-mail: jmstraughn@yahoo.com.

Received November 27, 2001. Received in revised form January 30, 2002. Accepted February 21, 2002.

© 2002 The American College of Obstetricians and Gynecologists