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Damage-Control Surgery for Obstetric Hemorrhage

Pacheco, Luis D., MD; Lozada, M. James, DO; Saade, George R., MD; Hankins, Gary D. V., MD

doi: 10.1097/AOG.0000000000002743
Maternal Morbidity and Mortality: Current Commentary: PDF Only

Damage-control surgery (abdominopelvic packing followed by a period of medical stabilization in the intensive care unit) is a life-saving intervention usually reserved for critically injured patients who may not survive an attempt to achieve hemostasis and complete repair of the damage in the operating room. Most obstetricians have little or no experience in this area, although the use of damage-control surgery in selected cases may be life-saving. This approach should be considered when arterial bleeding has been controlled and persistent bleeding is deemed to be secondary to coagulopathy that is refractory to blood product replacement, particularly in the presence of hypothermia, acidosis, and vasopressor requirement. A prototypical (albeit hypothetical) case is described here in which damage-control surgery is indicated.

Using damage-control surgery in selected cases of severe obstetric hemorrhage may be life-saving.

Departments of Obstetrics & Gynecology and Anesthesiology, the University of Texas Medical Branch, Galveston, Texas; and the Division of Obstetrical Anesthesiology, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.

Corresponding author: Luis D. Pacheco, MD, The University of Texas Medical Branch at Galveston, 301 University Boulevard, Galveston, TX 77555-0587; email: ldpachec@utmb.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has indicated that he has met the journal's requirements for authorship.

Received March 27, 2018

Received in revised form May 16, 2018

Accepted May 17, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.