Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 17, Section 3, Ren Min Nan Lu, Chengdu, Sichuan, People's Republic of China.
Arch Gynecol Obstet. 2012 Feb;285(2):285-9. doi: 10.1007/s00404-011-1935-5. Epub 2011 Jun 7.
To determine the safety and effectiveness of uterine packing in the management of intractable hemorrhage during cesarean section for central placenta previa.
This retrospective study was conducted on 70 pregnant women with central placenta previa from May 2005 to March 2010. Patients with uterine packing in the control of massive hemorrhage during cesarean section were identified. The indications, uterine packing procedures, estimated blood loss, postoperative complications, and packing material used were reviewed.
A total of 70 patients were identified among 1,121 women with placenta previa during the study period. Sixty-five cases were successful in the control of intraoperative bleeding using uterine packing. Two patients with severe placenta accreta had hemorrhage during cesarean section, and packing with gauze in the uterine cavity was not able to control the bleeding, thereby resulting in cesarean hysterectomy. One case demonstrated failure in packing because of disseminated intravascular coagulation occurring before hospital admission. The remaining two patients had massive vaginal bleeding after uterine packing in cesarean section and underwent laparotomy or hysterectomy 4 h postoperative.
Uterine packing is a safe and effective technique in the control of intractable hemorrhage in cesarean section. It is a reasonable alternative to further surgical intervention in patients with intractable obstetric hemorrhage, especially in developing countries.
探讨剖宫产术中应用宫腔填塞治疗中央型前置胎盘产后难治性出血的安全性和有效性。
回顾性分析 2005 年 5 月至 2010 年 3 月间收治的 70 例中央型前置胎盘剖宫产术中难治性出血患者的临床资料，对术中应用宫腔填塞治疗产后大出血的适应证、填塞方法、出血量、术后并发症、填塞材料等进行分析。
本研究共纳入 1121 例前置胎盘患者，70 例（6.28%）术中发生难以控制的大出血，采用宫腔填塞治疗，其中 65 例成功止血，2 例严重胎盘植入患者因纱布填塞未能控制出血而行子宫切除术，1 例因入院前已发生弥散性血管内凝血导致填塞失败，2 例术后 4 h 出现严重的阴道出血，改行剖腹探查或子宫切除术。
剖宫产术中应用宫腔填塞治疗中央型前置胎盘产后难治性出血是安全有效的方法，尤其在发展中国家，对于难以控制的产科出血，是一种合理的替代进一步手术干预的方法。
