Modified Abdominal-pelvic Packing for Intractable Hemorrhage after Postpartum Hysterectomy at Uthaithani Hospital

Abstract

Objective: To estimate efficacy and safety of modified abdominal-pelvic packing (MAP) in controlling persistent bleeding after subtotal hysterectomy in patients with postpartum hemorrhage from uterine causes.

Materials and Methods: This retrospective study was conducted in Uthaithani Hospital between January 2016 to January 2021. Among 24 pregnant women who developed severe postpartum hemorrhage requiring hysterectomy, we identified a group of 8 patients that hemorrhage cannot be controlled and required MAP. The remaining 16 patients did not require MAP. Surgical outcomes and complications were compared between both groups. Statistical comparisons were performed using Mann–Whitney U test and Fisher’s exact test or Chi-square test. A p-value < 0.05 was considered statistically significant.

Results: Both groups were similar in terms of demographic characteristics and maternal outcomes. Pre-operative amount of blood loss was higher in the MAP group (1,000.00 ml) compared to non-MAP group (550.00 ml), but was not significantly different (p = 0.378). MAP could successfully control bleeding in all of the packing group. There were no significant differences in operative amount of blood loss (1,050.00 vs 1,000.00; p = 0.854), febrile morbidity, shock, DIC and re-operation rate between both groups.

Conclusion: MAP is effective and safe for controlling persistent bleeding from raw surface after subtotal hysterectomy in patients with postpartum hemorrhage from uterine causes. This hemostatic procedure is feasible in hospital setting with limited resources.