Modified abdominal packing method in “near miss” patients with postpartum hemorrhages

Abstract

Objective:To describe a more effective abdominal packing method in patients with disseminated intravascular coagulation following peripartum hysterectomy due to postpartum hemorrhage (PPH).Materials and Methods:The present retrospective and descriptive study was conducted to document six cases with refractory pelvic bleeding who underwent a second surgery for PPH between January 2016 and December 2017 at İstanbul Zeynep Kamil Woman and Children Diseases Training and Research Hospital.Results:Karateke packing was performed to control intra-abdominal massive hemorrhages of five women who were referred to our clinic due to PPH who had undergone peripartum hysterectomy and hypogastric artery ligation but hemostasis could not be provided. In addition, a case of hypovolemic shock due to placenta percreta rupture in a woman who had also undergone an emergency hysterectomy and hypogastric artery ligation, which had failed. Hemostasis was provided in all patients. No method-related complication developed.Conclusion:Karateke packing is a very easy method to perform, it is more effective than the classic abdominal packing technique, with a low complication rate, and most importantly, life-saving in patients undergoing a peripartum hysterectomy due to PPH and thereafter experiencing diffuse hemorrhage.

Abdominal Packing for Obstetric Surgical Uncontrollable Hemorrhage

“…Second, by inflating or deflating the balloon, it is simpler to alter the balloon packs' sizes to match the hemorrhagic areas' sizes. However, it could be difficult to add or remove a pad from the assembled pack [15].…”

“…A patient who is hemodynamically unstable and not receiving optimal resuscitation, stabilization of the patient to allow transfer to an appropriate facility, post-hysterectomy hemorrhage with a free interval, diffuse vaginal laceration associated with pelvic bleeding, and the presence of extensive hematoma in the absence of embolization potential are indications for abdominal packing [15].…”

“…When there is enough traction, the distal end of the balloon is fastened to the patient's leg. After that, the skin is stitched up without tying the layers of the abdominal fascia [15]. When there is enough traction, the distal end of the balloon is fastened to the patient's leg.…”

“…Up till hemostasis is achieved, this treatment is continued. Following the replenishment of blood and blood products, the depacking treatment was carried out in all patients once the coagulation parameters had returned to the normal range and intra-abdominal hemorrhage had stopped [15]. The patient's blood pressure is adjusted to ensure that venous bleeding has been managed.…”

“…By raising the traction force and volume of the intraabdominal balloon in the Karateke packing technique, the compression strength applied to the bleeding location can be increased using the same number of sponges. As a result, it is possible to provide more mechanical pressure to bleeding foci without relaparotomy to add more sponges [15]. According to [16], 62 percent of abdominal packing procedures are successful.…”