Role of pelvic packing in massive obstetric haemorrhage with severe coagulopathy: a case report
Background. Massive obstetric hemorrhage (MOH) frequently causes disseminated intravascular coagulation (DIC). MOH with DIC often become fatal, especially in developing countries. We report pelvic packing as a successful treatment for this condition.
Case presentation. A 29-year-old female, who gave abdominal birth to a term infant 9 hours ago in another institute, presented to us due to unconscious (Glasgow coma scale (GCS): 3) and immediately after she had a cardiopulmonary arrest. Ultrasound revealed massive intraabdominal bleeding, and thus exploration laparotomy was done. Laparotomy revealed a posterior uterine tear with broad ligament and retroperitoneal hematoma: emergency hysterectomy with bilateral internal iliac ligation were performed. Because of the severe DIC, oozing persisted after the procedure; thus, trans peritoneally 5 gauze towels was inserted as a gauze packing deep into her pelvis and removed after 48 hours. We also performed anti-DIC treatment. Hemorrhage was controlled and the patient was discharged without complications after 23 days.
Conclusions. Pelvic packing is a lifesaving strategy for MOH complicated by severe DIC, especially in developing countries.