Abdomino-pelvic packing revisited: An often forgotten technique for managing intractable venous obstetric haemorrhage.

Abstract

Surgical packing should not be seen as a 'bail out' for the less skilled obstetrician who is unable to control obstetric haemorrhage using conventional techniques. Rather, this should be considered in cases of coagulopathy or where haemorrhage persists from raw surfaces, venous plexuses and inaccessible areas. Data from seven women who underwent abdomino-pelvic packing for intractable postpartum bleeding were collected. The primary outcome was success of intra-abdominal packing and secondary outcomes included estimated blood loss, units transfused, length of stay and postoperative complications. All seven women (median age 39years, interquartile range (IQR) 3.25) had caesarean section deliveries with median estimated blood loss of 5521.4mL (IQR 4475) and median of 6.9 (IQR 4.75) units transfused. Abdomino-pelvic packing was successful in all cases including in three women who had continued bleeding after peripartum hysterectomy. In the remaining four, bleeding stopped with packing, enabling the uterus to be conserved. The median number of packs inserted was 6.1 (IQR 4.2) and median shock index at time of decision to pack was 0.98 (IQR 0.13). The median pack dwell time was 30.8h (IQR 24), while median length of stay following removal was 48h (IQR 2.14). Intractable bleeding in these seven cases was successfully controlled by abdomino-pelvic packing, allowing supportive correction of hypothermia, tissue acidosis, coagulopathy and hypovolemia. The technique of packing is an essential skill in managing massive obstetric haemorrhage, in addition to uterine balloon tamponade, compression sutures and peripartum hysterectomy.