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Maternal outcome after abdominal packing for uncontrolled postpartum hemorrhage despite peripartum hysterectomy
BACKGROUND: Intra-abdominal packing is a possible option for persistent bleeding following hysterectomy for postpartum hemorrhage. However, to date, only very limited data about maternal outcome after intra-abdominal packing for surgically uncontrolled hemorrhage following hysterectomy are available...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5453422/ https://www.ncbi.nlm.nih.gov/pubmed/28570643 http://dx.doi.org/10.1371/journal.pone.0177092 |
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author | Deffieux, Xavier Vinchant, Marie Wigniolle, Ingrid Goffinet, François Sentilhes, Loïc |
author_facet | Deffieux, Xavier Vinchant, Marie Wigniolle, Ingrid Goffinet, François Sentilhes, Loïc |
author_sort | Deffieux, Xavier |
collection | PubMed |
description | BACKGROUND: Intra-abdominal packing is a possible option for persistent bleeding following hysterectomy for postpartum hemorrhage. However, to date, only very limited data about maternal outcome after intra-abdominal packing for surgically uncontrolled hemorrhage following hysterectomy are available. The objective of the current study was to estimate maternal outcome after intra-abdominal packing following unsuccessful peripartum hysterectomy for postpartum hemorrhage. METHODS: A questionnaire was mailed to all maternity units performing more than 850 deliveries per year. Inclusion criteria were: all cases of abdominal packing performed following unsuccessful peripartum hysterectomy for postpartum hemorrhage between 2003 and 2013. The primary outcome was success of intra-abdominal packing, defined as the arrest of hemorrhage with no need of additional procedure. RESULTS: The total number of deliveries during the study period that occurred in the 51 participating centers was 1,430,142. The centers reported a total of 718 (1 per 2000 deliveries) peripartum hysterectomies for PPH and 53 abdominal packings performed after unsuccessful peripartum hysterectomy (about 1 per 14 hysterectomies). A median of 5 [IQR 3–7] pads were used for packing. Abdominal packing was removed after a median of 39.5 hours [IQR 24–48]. The success rate of abdominal packing was 62% (33/53). Among the 20 (38%) women in whom bleeding did not stop following the use of abdominal packing, 6 required a second surgical intervention, 6 a pelvic artery embolization and the 8 other women had “only” further intensive resuscitation and pharmacological treatments. Finally, mortality rate was 24% (13/53). CONCLUSION: Our results suggest that abdominal packing, used for duration of 24 to 48 hours, seems to be an option as an ultimate procedure to control persistent life-threatening postpartum hemorrhage following peripartum hysterectomy. |
format | Online Article Text |
id | pubmed-5453422 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-54534222017-06-12 Maternal outcome after abdominal packing for uncontrolled postpartum hemorrhage despite peripartum hysterectomy Deffieux, Xavier Vinchant, Marie Wigniolle, Ingrid Goffinet, François Sentilhes, Loïc PLoS One Research Article BACKGROUND: Intra-abdominal packing is a possible option for persistent bleeding following hysterectomy for postpartum hemorrhage. However, to date, only very limited data about maternal outcome after intra-abdominal packing for surgically uncontrolled hemorrhage following hysterectomy are available. The objective of the current study was to estimate maternal outcome after intra-abdominal packing following unsuccessful peripartum hysterectomy for postpartum hemorrhage. METHODS: A questionnaire was mailed to all maternity units performing more than 850 deliveries per year. Inclusion criteria were: all cases of abdominal packing performed following unsuccessful peripartum hysterectomy for postpartum hemorrhage between 2003 and 2013. The primary outcome was success of intra-abdominal packing, defined as the arrest of hemorrhage with no need of additional procedure. RESULTS: The total number of deliveries during the study period that occurred in the 51 participating centers was 1,430,142. The centers reported a total of 718 (1 per 2000 deliveries) peripartum hysterectomies for PPH and 53 abdominal packings performed after unsuccessful peripartum hysterectomy (about 1 per 14 hysterectomies). A median of 5 [IQR 3–7] pads were used for packing. Abdominal packing was removed after a median of 39.5 hours [IQR 24–48]. The success rate of abdominal packing was 62% (33/53). Among the 20 (38%) women in whom bleeding did not stop following the use of abdominal packing, 6 required a second surgical intervention, 6 a pelvic artery embolization and the 8 other women had “only” further intensive resuscitation and pharmacological treatments. Finally, mortality rate was 24% (13/53). CONCLUSION: Our results suggest that abdominal packing, used for duration of 24 to 48 hours, seems to be an option as an ultimate procedure to control persistent life-threatening postpartum hemorrhage following peripartum hysterectomy. Public Library of Science 2017-06-01 /pmc/articles/PMC5453422/ /pubmed/28570643 http://dx.doi.org/10.1371/journal.pone.0177092 Text en © 2017 Deffieux et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Deffieux, Xavier Vinchant, Marie Wigniolle, Ingrid Goffinet, François Sentilhes, Loïc Maternal outcome after abdominal packing for uncontrolled postpartum hemorrhage despite peripartum hysterectomy |
title | Maternal outcome after abdominal packing for uncontrolled postpartum hemorrhage despite peripartum hysterectomy |
title_full | Maternal outcome after abdominal packing for uncontrolled postpartum hemorrhage despite peripartum hysterectomy |
title_fullStr | Maternal outcome after abdominal packing for uncontrolled postpartum hemorrhage despite peripartum hysterectomy |
title_full_unstemmed | Maternal outcome after abdominal packing for uncontrolled postpartum hemorrhage despite peripartum hysterectomy |
title_short | Maternal outcome after abdominal packing for uncontrolled postpartum hemorrhage despite peripartum hysterectomy |
title_sort | maternal outcome after abdominal packing for uncontrolled postpartum hemorrhage despite peripartum hysterectomy |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5453422/ https://www.ncbi.nlm.nih.gov/pubmed/28570643 http://dx.doi.org/10.1371/journal.pone.0177092 |
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