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Pelvic Packing for Intractable Obstetric Hemorrhage After Emergency Peripartum Hysterectomy: A Review

Touhami, Omar, MD*; Bouzid, Arij, MD; Ben Marzouk, Sofiene, MD; Kehila, Mahdi, MD§; Channoufi, Mohamed, Badis, MD§¶; El Magherbi, Hayen, MD

Obstetrical & Gynecological Survey: February 2018 - Volume 73 - Issue 2 - p 110–115
doi: 10.1097/OGX.0000000000000537
CME ARTICLES
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CME

Importance Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide. Even after emergency peripartum hysterectomy (EPH), bleeding may occur in the setting of acquired coagulopathy. This type of bleeding resistant to clipping, ligating, or suturing could be successfully controlled with a pelvic packing.

Objective This review provides an overview of the different pelvic packing techniques used after the failure of an EPH to control severe PPH. It aims to highlight the outcome of patients after packing, the morbidity and complications of packing, the timing and indications of packing, and finally the optimal duration of packing.

Evidence Acquisition Literature relating to pelvic packing after EPH in a PPH setting was reviewed.

Results Packing techniques can be divided into 2 types: pads or roller gauze and balloon pack. The overall success rate was as high as 78.8% with a mortality rate of 12.5%. No major morbidity related to the pelvic packing was documented. The optimal duration of packing is in the range of 36 to 72 hours.

Conclusions Pelvic packing should be part of the armamentarium available to the obstetrician whenever intractable pelvic hemorrhage is encountered. It is quite simple and quick to perform and requires no special medical materials, the rate of complications is very low, and the success rate is high.

Relevance The pelvic packing should be particularly useful in developing countries where more advanced technologies such as selective arterial embolization are not always available. In developed countries, the pelvic packing may be a valuable temporary measure pending transport to a tertiary care facility.

Target Audience Obstetricians and gynecologists, family physicians.

Learning Objectives After completing this activity, the learner should be better able to identify the situations were pelvic packing could be used as a lifesaving procedure; compare the different techniques of pelvic packing, highlighting the potential advantages and disadvantages of each technique; and evaluate the success rate of the procedure and the potential morbidity.

*Assistant Professor and †Resident in Obstetrics and Gynecology, “C” Department of Obstetrics and Gynecology, Tunis Maternity and Neonatology Center, Tunis El Manar University; ‡Assistant Professor, Anesthesiology and Reanimation Department, Tunis Maternity and Neonatology Center, Tunis El Manar University; §Professor and ¶Head, “C” Department of Obstetrics and Gynecology, Tunis Maternity and Neonatology Center, Tunis El Manar University; and ∥Professor and Head, Anesthesiology and Reanimation Department, Tunis Maternity and Neonatology Center, Tunis El Manar University, Tunis, Tunisia

All authors, faculty, and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.

Correspondence requests to: Omar Touhami, MD, “C” Department of Obstetrics and Gynecology, Tunis Maternity and Neonatology Center, Tunis el Manar University, Jabel-Lakhdar Street, La Rabta, 1007 Tunis, Tunisia. E-mail: Touhamiomar@yahoo.fr.

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