Uterine packing during cesarean section in the management of intractable hemorrhage in central placenta previa.

OBJECTIVE

To determine the safety and effectiveness of uterine packing in the management of intractable hemorrhage during cesarean section for central placenta previa.

METHODS

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.

RESULTS

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.

CONCLUSION

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.