Uterine packing during cesarean section in the management of intractable hemorrhage in central placenta previa. 2012

Junli Ge, and Hua Liao, and Lijun Duan, and Qiang Wei, and Weiyue Zeng
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.

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. CONCLUSIONS 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.

UI MeSH Term Description Entries
D007044 Hysterectomy Excision of the uterus. Hysterectomies
D010921 Placenta Accreta Abnormal placentation in which all or parts of the PLACENTA are attached directly to the MYOMETRIUM due to a complete or partial absence of DECIDUA. It is associated with POSTPARTUM HEMORRHAGE because of the failure of placental separation. Morbidly Adherent Placenta,Placenta Accreta Spectrum,Placenta Increta,Placenta Percreta,Accreta Spectrum, Placenta,Accreta, Placenta,Adherent Placenta, Morbidly,Increta, Placenta,Morbidly Adherent Placentas,Percreta, Placenta,Placenta, Morbidly Adherent
D010923 Placenta Previa Abnormal placentation in which the PLACENTA implants in the lower segment of the UTERUS (the zone of dilation) and may cover part or all of the opening of the CERVIX. It is often associated with serious antepartum bleeding and PREMATURE LABOR. Placenta Praevia
D011247 Pregnancy The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH. Gestation,Pregnancies
D001810 Blood Volume Volume of circulating BLOOD. It is the sum of the PLASMA VOLUME and ERYTHROCYTE VOLUME. Blood Volumes,Volume, Blood,Volumes, Blood
D002585 Cesarean Section Extraction of the FETUS by means of abdominal HYSTEROTOMY. Abdominal Delivery,Delivery, Abdominal,C-Section (OB),Caesarean Section,Postcesarean Section,Abdominal Deliveries,C Section (OB),C-Sections (OB),Caesarean Sections,Cesarean Sections,Deliveries, Abdominal
D005260 Female Females
D006473 Postpartum Hemorrhage Excess blood loss from uterine bleeding associated with OBSTETRIC LABOR or CHILDBIRTH. It is defined as blood loss greater than 500 ml or of the amount that adversely affects the maternal physiology, such as BLOOD PRESSURE and HEMATOCRIT. Postpartum hemorrhage is divided into two categories, immediate (within first 24 hours after birth) or delayed (after 24 hours postpartum). Hemorrhage, Postpartum,Delayed Postpartum Hemorrhage,Immediate Postpartum Hemorrhage,Hemorrhage, Delayed Postpartum,Hemorrhage, Immediate Postpartum,Postpartum Hemorrhage, Delayed,Postpartum Hemorrhage, Immediate
D006488 Hemostasis, Surgical Control of bleeding during or after surgery. Surgical Hemostasis,Hemostases, Surgical,Surgical Hemostases
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man

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