Utero-vaginal packing. Seven years review in the management of post partum hemorrhage due to placenta previa/accreta at a maternity hospital in Central Saudi Arabia

Objectives: To study the effectiveness of utero-vaginal packing in the management of primary postpartum hemorrhage due to placenta previa/accreta. Methods: We conducted this study in the Maternity Hospital, Riyadh Medical Complex, Riyadh, Saudi Arabia. This is a retrospective study covering 7 years from January 2001 to December 2007. Utero-vaginal packing was carried out by placing gauze soaked in normal saline solution approximately 2 meters long and 10 cm in width into the lower uterine segment through the cesarean incision, with its end passed through the cervix into the vagina. Routine closure of the cesarean incision was performed, and then another similar pack was inserted into the vaginal fornices to counteract the pressure effect of the uterine pack and compress the pelvic vessels. Results: In 83 patients with post partum hemorrhage caused by placenta previa/accreta, 48 of them underwent utero-vaginal packing alone as a conservative measure in the management of bleeding. Three of them needed second surgical intervention, however, there was no maternal death among the series. Conclusion: Utero-vaginal packing is of benefit in achieving hemostasis in cases of post partum hemorrhage due to low lying placenta previa/accreta and conserving the uterus particularly in women with low parity.