Control of postpartum hemorrhage by uterine packing is not new15. For many years, uterine packing with sterile gauze has been used in the clinical management of severe postpartum hemorrhage and as the last resort before hyster-ectomy16. Because of the availability of better uterotonic medications, this practice lost its appeal, but reports on its successful use continued to appear17-19. Recently, some authors raised concerns about concealed bleeding and infection20; a newer technique, however, has allayed some of these concerns21.
Uterovaginal packing may sometimes obviate the need for surgery altogether. In cases of deliveries complicated by postpartum hemorrhage, after excluding uterine rupture, genital tract lacerations, and retained placental tissue, efforts are directed toward contracting the uterus by bimanual compression and uterotonic agents. If these are not successful, one must resort to surgical techniques. At this stage, an alternative option to remember is uterovaginal packing. Easy and quick to perform, it may be used to control bleeding by tamponade effect and stabilize the patient until a surgical procedure is arranged.
Chapter 28 describes the technique of uterine packing in more detail.
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