Abdominal packing in postpartum hemorrhage: A forgotten life-saving technique

BACKGROUND: Postpartum hemorrhage is a major cause of maternal morbidity and mortality. Abdominal packing is a technique used to control bleeding when other methods fail. This study aimed to evaluate the outcomes of patients who underwent abdominal packing for postpartum hemorrhage.
METHODS: This retrospective study included 11 patients who underwent abdominal packing for severe obstetric hemorrhage (10 cases of postpartum hemorrhage and one case of second-trimester pregnancy termination complicated by severe hemorrhage) at Mersin University Faculty of Medicine Hospital between 2005 and 2023. Data were collected from medical records. The primary outcome was the successful immediate control of refractory hemorrhage and temporary stabilization of the patient's hemodynamic status. Secondary outcomes included transfusion requirements, complications, and length of hospital stay.
RESULTS: All 11 patients underwent hysterectomy for postpartum hemorrhage and subsequently required abdominal packing due to persistent bleeding. The median age was 33 years, and the median gravidity was 3. The primary causes of postpartum hemorrhage were uterine atony (54.5%), placenta previa (36.4%), and disseminated intravascular coagulation (9.1%). The median number of packs used was 3, and packs were removed after 24 hours in all cases. Abdominal packing successfully controlled persistent bleeding in all patients following hysterectomy. The median length of hospital stay was 6 days. All patients required blood transfusions. The most common complication was pulmonary edema (90.9%). All patients survived.
CONCLUSION: Abdominal packing may serve as a valuable temporary rescue measure for severe, refractory obstetric hemorrhage in selected cases where conventional methods are insufficient. Careful patient selection and close postoperative monitoring are essential.

Keywords: Postpartum hemorrhage, Abdominal packing, Hysterectomy, Maternal morbidity, Mortality

Doðum sonrasý kanamada abdominal packing: Unutulmuþ bir hayat kurtarma tekniði

AMAÇ: Postpartum kanama maternal morbidite ve mortalitenin önemli bir nedenidir. Abdominal packing, diðer yöntemler baþarýsýz olduðunda ka-namayý kontrol etmek için kullanýlan bir tekniktir. Bu çalýþmanýn amacý postpartum kanama nedeniyle abdominal packing tekniði uygulanan hastalarýn sonuçlarýný deðerlendirmektir.
GEREÇ VE YÖNTEM: Bu retrospektif çalýþmaya 2005-2023 yýllarý arasýnda Mersin Üniversitesi Týp Fakültesi Hastanesi'nde postpartum kanama nedeniyle abdominal packing uygulanan 11 hasta dahil edildi. Veriler týbbi kayýtlardan toplandý. Birincil sonuç, daha fazla operasyon gerektirmeden abdomino-pelvik packingin etkinliðiydi. Ýkincil sonuçlar kanama, transfüzyonlar, komplikasyonlar ve hastanede yatýþ süresini kapsamaktadýr. BULGULAR: 11 hastanýn hepsine postpartum kanama nedeniyle histerektomi yapýldý ve devam eden kanama nedeniyle abdominal packing uygulan-dý. Postpartum kanamanýn ana nedenleri uterus atonisi (%54.5), plasenta previa (%36.4) ve dissemine intravasküler koagülasyon (%9.1) idi. Kullanýlan ortalama kompres sayýsý 3 idi ve tüm hastalara 1 gün süreyle yerleþtirildi. Abdominal packing, histerektomi sonrasý tüm vakalarda inatçý kanamayý etkili bir þekilde kontrol altýna almýþtýr. Hastanede yatýþ süresi median 6 gündü. Tüm hastalara kan transfüzyonu gerekmiþtir. En yaygýn komplikasyon akciðer ödemiydi (%90.9). Tüm hastalar hayatta kaldý.
SONUÇ: Abdominal packing tekniði, özellikle diðer yöntemler baþarýsýz olduðunda, þiddetli postpartum kanama için hayat kurtarýcý bir giriþim olabi-lir. Dikkatli hasta seçimi ve ameliyat sonrasý izlem þarttýr.

Anahtar Kelimeler: Postpartum kanama, Abdominal packing, Histerektomi, Maternal morbidite, Mortalite