Primary PPH; Role of uterine packing in control of haemorrhage

ABSTRACT

To determine the effectiveness and safety of uterine packing in selected cases of primary postpartum haemorrhage. Cross-sectional study. The study was conducted at Jinnah Postgraduate Medical Centre, Karachi, From September 2003 to April 2008. Women developing primary PPH due to uterine atony, placenta previa and coagulation failure were selected for uterine packing. Firm packing was done with enormous length of sterile ribbon gauze, using 'layering technique' under prophylactic antibiotic cover. Vagina was also packed to give additional pressure. Pack was removed after 12 - 36 hours or early in case of failure to control haemorrhage. Pulse, blood pressure, soakage of pads, height of uterine fundus and temperature were monitored to assess effectiveness and safety. 39 women were included in the study. Cause of PPH was uterine atony in 30 [76.9%], coagulation failure in 5 [12.8%] and placenta previa in 4 [10.3%] cases. Packing was successful in arresting haemorrhage in 32 [82.1%] and failed in 7 [17.9%] cases; 95% Confidence Interval 67-91. There was no case of concealed haemorrhage, four patients developed emdometritis and none had delayed haemorrhage. 13 laparotomies were prevented. The difference between the causes of haemorrhage in successful and failed cases did not show a definite trend. If employed early, uterine packing is a quick, effective and safe method for controlling primary PPH in carefully selected cases