An Effective Pressure Pack for Severe Pelvic Hemorrhage.
Dildy, Gary A. MD; Scott, James R. MD; Saffer, Craig S. MD; Belfort, Michael A. MD, PhD
Obstetrics & Gynecology.
108(5):1222-1226, November 2006.
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OBJECTIVE: To evaluate our experience with the "pelvic pressure pack," a surgical technique for controlling posthysterectomy bleeding.
METHODS: This is an observational descriptive report of cases collected by the authors during the years 1968-2006. Packs were constructed of various materials (eg, pillow cases, gauze sheets, plastic X-ray cassette drapes, or orthopedic stockings) filled with gauze rolls introduced abdominally and exiting the vagina.
RESULTS: We report 11 new cases (10 obstetric and one gynecologic). Massive red blood cell transfusion and coagulopathy occurred in all cases. The pelvic pressure pack successfully controlled bleeding in 82% (9 of 11) of cases. Postoperative febrile morbidity occurred in most cases. There were no maternal deaths.
CONCLUSION: In the contemporary management of posthysterectomy bleeding, the pelvic pressure pack appears to be a valuable surgical option, affording correction of coagulopathy and further stabilization. Given near-universal postoperative febrile morbidity in our series, prophylactic broad-spectrum antibiotic therapy should be strongly considered. We believe all obstetrician-gynecologists should be familiar with this simple, potentially life-saving technique.
LEVEL OF EVIDENCE: III
(C) 2006 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.