Effectiveness of Utero-Vaginal Packing in Management of Postpartum Hemorrhage

摘要

A major cause of maternal mortality and morbidity in developing world is postpartum hemorrhage (PPH). Different management options have been in use including use of oxytocins, prostaglandins, surgical exploration of genital tract, ligation or angiographic embolization of uterine/internal iliac arteries and hysterectomy. A simple and effective measure is to control bleeding with uterovaginal packing which is easy and quick to perform and saves the patient need of major surgical procedures.Objective: To determine effectiveness of uterovaginal packing in control of postpartum hemorrhage, its safety and complications associated with it.Place and Duration of Study: This study was carried out in Gynae unit 1 of Lady Willingdon Hospital Lahore from January 2014 – June 2015.Patients and Methods: It was a prospective interventional study. The patients presenting with postpartum hemorrhage after vaginal or abdominal delivery who did not respond to medical management were included in the study. Patients who had PPH due to genital tract trauma were excluded from this study. Frequencies and proportions of complications were calculated along with rate of successful cessation of bleeding. Data was analyzed by SPSS version 11.Results: 99 patients who presented with PPH were included in study.49.5% were between age of 31 – 40 years, 38.4% were between 21– 30 years. 8.1% of patients were P1-2, 52.5% were P3-5 and 39.4% were P6 and above. 76.7% had hemorrhage after vaginal delivery and 23.3% after lower segment caesarean section. Uterineatony was the most common cause of postpartum hemorrhage, seen in 78.78% of cases, 9.09% had placenta previa, 8.08% presented with abruption placenta and 4.04% had coagulopathy. Regarding complications 7 women had to undergo hysterectomy, fever occurred in 14.14%, 8.08% had wound infection and 2 patients died of Disseminated Intravascular Coagulation (DIC). Procedure was successful in 90.9% of cases.Conclusion: Utero-vaginal packing effectively controls postpartum hemorrhage with fewer complications and its role in emergency obstetric scan not be denied.