Use of packing in obstetric hemorrhage of uterine origin

OBJECTIVE: To determine the safety and effectiveness of uterine packing to stop hemorrhage in obstetric patients following delivery and pregnancy termination. STUDY DESIGN: A review of obstetric records at Children's Hospital of Buffalo in a 9-year period was undertaken. Patients with uterine packing were identified. Indications, additional medical and surgical procedures, estimated blood loss, postoperative complications and packing material used were reviewed. RESULTS: A total of 9 patients were identified among 34,071. Five patients had hemorrhage during cesarean section. Two patients had hemorrhage after vaginal delivery; 1 case of which had failure with packing and resulted in postpartum hysterectomy. The remaining 2 patients had hemorrhage after dilation and evacuation. Uterine atony unresponsive to oxytocics was the most common indication for uterine packing (44%). The average hematocrit decrease was 10.4% (average total blood loss, 2,200 mL), and all patients received transfusion except 1. The only immediate postoperative complications occurred in a patient with postpartum hysterectomy after failed packing; she developed a pelvic abscess but did well after drainage. CONCLUSION: Uterine packing may be a reasonable alternative to further surgical intervention in patients with intractable obstetric hemorrhage who wish to preserve fertility.