Resumo
Background: Postpartum haemorrhage (PPH) remains a leading contributory factor to maternal morbidity and mortality especially among women undergoing caesarean deliveries. Despite concerted efforts being made towards prevention, recurrent limiting factors in low-resource settings warrant the adoption of mechanisms that would further assist in combating the scourge. This study reviewed the outcome of intra-operative uterine packing of bleeding uteri in limiting blood loss from PPH.
Methods: We reviewed the hospital records of patients who had postpartum haemorrhage over a period of five months retrospectively and present the outcome of 17 consecutive cases which were managed with intrauterine packing with abdominal mop as an adjunct measure. Structured proforma was used to obtain information on age, parity, socioeconomic status, mode of delivery, indications for surgery and history of intrauterine packing from the hospital records while data analysis was done using the statistical package for social sciences, SPSS, version 23.0.
Results: Most common cause of intraoperative PPH was uterine atony, 13 (76.5%), and the mean blood loss was 1841.2±1165.4mL. Mean duration of intrauterine packing was 36.7±15.0 hours and average number of days on admission was 4.0±2.5.An average of 2 abdominal mops was used per packing and most procedures were performed by the medical officers (10, 58.8%). Overall, there was no case of maternal mortality among the patients managed and no abnormality was detected on follow up at 6 weeks.
Conclusion: Uterine gauze packing is effective in reducing blood loss from intra-operative PPH in low resourcesettings. It, therefore, deserves a re-consideration as an addition to the armamentarium of available resources for reducing mortalities from PPH in developing countries.
Keywords: Atony, Caesarean delivery, intrauterine packing, Postpartum Haemorrhage.
Résumé
Contexte: L’hémorragie du post-partum (HPP) reste l’un des principaux facteurs contribuant à la morbidité et à la mortalité maternelles, en particulier chez les femmes qui accouchent par césarienne. Malgré des efforts concertés de prévention, les facteurs limitatifs récurrents dans les pays à faibles ressources justifient l’adoption de mécanismes qui contribueraient davantage à lutter contre le fléau. Cette étude a examiné les résultats de la compression utérine peropératoire des saignements utérins en limitant la perte de sang due à l’HPP.
Méthodes: Nous avons revu rétrospectivement les dossiers hospitaliers des patientes ayant eu une hémorragie postpartum sur une période de cinq mois et présentons le résultat de 17 cas consécutifs qui ont été gérés avec un emballage intra-utérin avec une vadrouille abdominale comme mesure d’appoint. Un formulaire structuré a été utilisé pour obtenir des informations sur l’âge, la parité, le statut socio-économique, le mode d’accouchement, les indications pour la chirurgie et les antécédents d’emballage intra-utérin à partir des dossiers de l’hôpital, tandis que l’analyse des données a été effectuée à l’aide du progiciel statistique pour les sciences sociales, SPSS, version 23.0.
Résultats: La cause la plus fréquente d’HPP peropératoire était l’atonie utérine, 13 (76,5%), et la perte sanguine moyenne était de 1841,2 ± 1165,4 ml. La durée moyenne de l’emballage intra-utérin était de 36,7 ± 15,0 heures et le nombre moyen de jours d’admission était de 4,0 ± 2,5. Une moyenne de 2 vadrouilles abdominales a été utilisée par emballage et la plupart des interventions ont été effectuées par les médecins (10, 58,8%). Dans l’ensemble, il n’y a pas eu de cas de mortalité maternelle parmi les patientes prises en charge et aucune anomalie n’a été détectée au suivi à 6 semaines.
Conclusion: L’emballage de gaze utérine est efficace pour réduire la perte de sang due à l’HPP peropératoire dans les milieux à faibles ressources. Il mérite donc d’être réexaminé comme un ajout à l’arsenal de ressources disponibles pour réduire les mortalités dues à l’HPP dans les pays en développement.
Mots clés: Atony, accouchement par césarienne, emballage intra-utérin, hémorragie post-partum.
Correspondence: Dr. T.A.O. Oluwasola, Department of Obstetrics and Gynaecology, University College Hospital, Ibadan and College of Medicine, University of Ibadan, Ibadan, Nigeria. E-mail: sesanoluwasola@yahoo.com
Referências
Bagga R, Jain V, Kalra J, Chopra S and Gopalan S. Uterovaginal packing with rolled gauze in postpartum hemorrhage. Medscape Gen Med2004; 6(1):50.
Iram M. Role of Uterine Packing in Control of PPH. P J M H S. 2011;5(3):442–444.
Li Y, Yin C, Chen F and Chao T. A Useful Technique for the control of severe cesarean hemorrhage/ : report of three cases. Chang Gung Med J. 2002;25(8):548–552.
Ali T, Ghazi A and Siddiq NM. Uterovaginal packing in massive postpartum haemorrhage – a reappraisal. Pakistan J Surg. 2008;24(1):57–59.
Maier RC. Control of postpartum hemorrhage with uterine packing. Am J Obstet Gynecol 1993;169(2):317–323.
Nwagha UI, Okaro JM and Nwagha TU. Intraoperative uterine packing with mops: an effective, but under utilized method of controlling post partum haemorrhage-experience from South Eastern Nigeria. Niger J Med 2005;14(3):279–282
Okafori I, Ugwu EO, Obis N and Nwogu-Ikojo EE. Uterine packing in the management of complete placenta praevia. Niger J Med 2014;23(4):321–324.
Evensen A, Anderson JM and Fontaine P. Postpartum Haemorrhage: Prevention and Treatment. Am Fam Physician. 2017; 95(7):442-449.
WHO. Trends in Mternal Mortality: 1990-2013. Estimates by WHO,UNICEF, UNFPA, The World Bank and the United Nations Population Division. World Health Organisation. 2014. Last Accessed 24 December, 2019. Available from: http://apps.who.int/iris/bitstream/10665/112682/2/9789241507226_eng.pdf?ua=1
Gulmezoglu AM, Souza JP and Mathai M. WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage. World Health Organization. 2012. 1-48 p. Last Accessed 24 December 2019. Available from: http://www.who.int/reproductivehealth/publications/maternal_perinatal_health
Ugwu IA, Oluwasola TA, Enabor OO, et al. Randomized controlled trial comparing 200 ìg and 400 ìg sublingual misoprostol for prevention of primary postpartum hemorrhage. Int J Gynecol Obstet 2016;133(2):173–177.
Pradhan B, RC L, Sharma P and Singh A. Uterovaginal packing as treatment in Primary Postpartum hemorrhage in Patan Hospital. Nepal J Obstet Gynaecol. 2016;11(21):44–46.
Nizam K and Haider G. Role of Uterovaginal Packing in Postpartum Hemorrhage. JLUMHS. 2010;9(1):27–29.
Shao Y and Pradhan M. Intrauterine Gauze Packing in Primary Post Partum Hemorrhage following Caesarean section/ : A Clinical study. Nepal J Obstet Gynaecol. 2012;7(1):33–36.
Yoong W, Sivashanmugarajan V, Mcmonagle M, et al. Pelvic and vaginal packing for intractable venous obstetric haemorrhage/ : practical tips for the obstetrician. Obstet Gynaecol. 2014;16:276–280.
Marwaha A, Singh P and Naniwal A. Role of Intrauterine Packing in Primary Post Partum Haemorrhage. Int J Sci Res. 2016;55(7):209–219.
Li GT, Li GR, Xu HM, Wu BP and Wang XN. Uterine folding hemostasis: a simpler and safer technique for controlling atonic postpartum hemorrhage. Arch Gynecol Obstet. Springer Berlin Heidelberg; 2016;294(4):689–695.
Li GT, Li XF, Liu YJ, Li W and Xu HM. Symbol “&” suture to control atonic postpartum hemorrhage with placenta previa accreta. Arch Gynecol Obstet. 2015;291(2):305–310.
Holzer I and Lehner R. Evaluation of process management of postpartum hemorrhage due to uterine atony. Open J Obstet Gynecol. 2013;3:514–519.
Aderoba AK, Olagbuji BN, Akintan AL, Oyeneyin OL and Owa OO. Condom-catheter tamponade for the treatment of postpartum haemorrhage and factors associated with success/ : a prospective observational study. Br J Obstet Gynaecol. 2016;124(11):1764–1771.
Danso D and Reginald PW. Internal Uterine Tamponade. In: Arulkumaran S, Karoshi M, Keith LG, Lalonde AB, B-Lynch C, editors. A Comprehensive Textbook of postpartum hemorrhage. 2nd ed. Sapiens Publishing; 2012. p. 377–380.
Tindell K, Garfinkel R, Abu-Haydar E, et al. Uterine balloon tamponade for the treatment of postpartum haemorrhage in resource-poor settings: A systematic review. Br J Obstet Gynaecol. 2013;120(1):5–14.
Hsu S, Rodgers B, Lele A and Yeh J. Use of packing in obstetric hemorrhage of uterine origin. J Reprod Med 2003;48(2):69–71.
Johanson R, Kumar M, Obhrai M and Young P. Management of massive postpartum haemorrhage/ : use of a hydrostatic balloon catheter to avoid laparotomy. Br J Obstet Gynaecol. 2001;108:420–422.
Ge J, Liao H, Duan L, Wei Q and Zeng W. Uterine packing during cesarean section in the management of intractable hemorrhage in central placenta previa. Arch Gynecol Obs. 2012;285:285–289.
Abdelrub AS and Al Harazi AH. Uterine packing during cesarean section is effective tool for arresting placental site postpartum hemorrhage. Sudan Med J. 2014;50(2):103–107.
Bello FA, Tsele TA and Oluwasola TO. Decision-to-delivery intervals and perinatal outcomes following emergency cesarean delivery in a Nigerian tertiary hospital. Int J Gynecol Obstet. 2015;130(3): 279-283.
Deffieux X, Vinchant M, Wigniolle I, et al. Maternal outcome after abdominal packing for uncontrolled postpartum hemorrhage despite peripartum hysterectomy. PLoS One 2017; 12: e0177092.
Okafori I, Ugwu EO, Obis N, et al. Uterine packing in the management of complete placenta praeuvia. Niger J Med 2014;23:321–324.
Kandeel M, Sanad Z, Ellakwa H, et al. Management of postpartum haemorrhage with intrauterine balloon tamponade using a condom catheter in an Egyptian setting. Int J GynaecolObstet 2016;135:272–275.
Wei J, Dai Y, Wang Z, et al. Intrauterine double-balloon tamponadevs gauze packing in the management of placenta previa: A multicentre randomized controlled trial. Medicine (Baltimore). 2020;99(7):e19221