Outcome of utero-vaginal packing in Primary Postpartum Hemorrhage in a teaching hospital.
Med Channel Jan ;12(3):17-20.
OBJECTIVES: 1: To determine the effectiveness of utero-vaginal packing (UVP) to control primary postpartum haemorrhage (PPH) due to atonic uterus. 2: To determine the complications of UVP during six weeks following the procedure. DESIGN: Quasi-experimental study SETTING: This study was conducted in the Department of Obstetrics & Gynecology, Kulsoombai Valika Social Security Hospital, Karachi, an affiliated hospital of Hamdard College of Medicine & Dentistry, between January 1999 to December 2004. PATIENTS & METHODS: UVP was performed when conventional methods had failed to control bleeding from an atonic postpartum uterus. Study patients were identified according to pre-set inclusion & exclusion criteria. UVP was performed under anesthesia, with long gauze rolls. The patients were observed for primary revealed hemorrhage & concealed hemorrhage. Total abdominal hysterectomy was carried out when UVP had failed. The patients were followed after discharge for 6 weeks after the procedure for evidence of secondary PPH & pelvic infection. RESULTS: During the study period, UVP was performed in 34 patients. The procedure was found successful in 31 ie., 91 % cases. Failure was observed in 3 cases which was recognized by primary revealed hemorrhage within half hour of the procedure. Pelvic infection was seen in 5 ie., 14.7 % cases, but pre-existing risk factors for infection such as prolonged rupture of membranes, obstructed labour and home delivery were present in all these cases. There was no case of concealed hemorrhage or secondary PPH. CONCLUSION: UVP seems to be an effective method for managing patients with atonic postpartum hemorrhage, with minimal maternal morbidity.
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