Volume : V, Issue : VII, July - 2016

ROLE OF INTRAUTERINE PACKING IN PRIMARY POST PARTUM HAEMORRHAGE

Dr Amarpreet Marwaha, Dr Piara Singh, Dr Ashok Naniwal

Abstract :

 Title–Role of intrauterine packing in primary postpartum hemorrhage Aims and Objective– 1. To Study various causes of primary PPH. 2. To Study management of primary PPH in cases of : (A) Vaginal Delivery (B) Caesarean Section 3. To Study efficacy of utero vaginal packing in controlling primary atonic PPH. 4. Outcome of uterine packing in atonic PPH. 5. Maternal morbidity following uterine packing in atonic PPH. Material and Methods–This is study of 100 cases of Primary PPH in vaginal delivery and caesarean section. Intrauterine packing was done with a variable length of sterile ribbon gauze. Vaginal route was used for woman who developed PPH after vaginal delivery. Firm packing was done in layering ribbon gauze from fundus to cervix. In case of caesarean section incision was closed, tip of ribbon gauze was observed for soakage.This study was conducted in Umaid Hospital, Department of Obst and Gynae, Jodhpur. METHOD–Intrauterine packing was done by using 8–10 meter gauze starting from the fundus with the help of sponge holding forceps up to the cervix.After securing bilateral uterine incision angles, uterus was packed with folded sterile gauze about 2m long and 10cm wide gauze in layers through the caesarean incision from one cornua to the other with a sponge holding forceps or with the help of the index and middle finger, from the fundus into the lower uterine segment with its end passing through the cervix into the vagina.Incision in lower segment was sutured continuously in two layers taking care not to include inadvertently the gauze into the sutures. Prophylactic oad–spectrum intravenous antibiotics coverage was used in all cases. Patients vital signs were taken every hour and vaginal bleeding was assessed. After giving mild sedative drugs, uterine packing was removed after 24–48 hours of insertion. According to the amount of blood loss and preoperative hemoglobin level blood transfusion was given. Postoperative complications were noted and patients were followed for upto six weeks in the outpatient clinic. Results– Among 100 patients ,50 patients were in the age group of 21 –25 year and only 8 patients were above age of 30 years.68 patients were from rural area and 81 % cases were from low socioeconomic status Uterine atony unresponsive to oxytocics was the commonest cause of postpartum hemorrhage, seen in 76 patients followed by placenta previa in 12 patients. 8 out of 9 required transfusion, in only 1 case, hemorrhage continued and a hysterectomy was done. Pack was removed earliest at 12 hours and maximum at 24 hours in successful cases in present study.77 patients had caesarean section and 23 patients had vaginal delivery as far as mode of delivery is concerned. Conclusion– Utero vaginal packing is effective in arresting the bleeding due to Primary PPH. In our setup, with limited and overburdened resources, utero vaginal packing still retains an important role in emergency obstetrics.. Patient at primary and secondary health care set up can be managed easily by intrauterine packing, it buys them time while transporting them to tertiary hospital.It is A Ray of Hope for such under privileged patients.Every obstetrician should be familiar with the technique of packing as this may save life, avoid laparotomy and conserve uterus.

Keywords :

Article: Download PDF   DOI : 10.36106/ijsr  

Cite This Article:

Dr Amarpreet Marwaha, Dr Piara Singh, Dr Ashok Naniwal ROLE OF INTRAUTERINE PACKING IN PRIMARY POST PARTUM HAEMORRHAGE International Journal of Scientific Research,Volume : 5 | Issue : 7 | July 2016

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