Abdominal packing in postpartum hemorrhage: A forgotten life-saving technique

BACKGROUND: Postpartum hemorrhage is a major cause of maternal morbidity and mortality. Abdominal packing is a technique used to control bleeding when other methods fail. This study aimed to evaluate the outcomes of patients who underwent abdominal packing for postpartum hemorrhage. METHODS: This retrospective study included 11 patients who underwent abdominal packing for severe obstetric hemorrhage (10 cases of postpartum hemorrhage and one case of second-trimester pregnancy termination complicated by severe hemorrhage) at Mersin University Faculty of Medicine Hospital between 2005 and 2023. Data were collected from medical records. The primary outcome was the successful immediate control of refractory hemorrhage and temporary stabilization of the patient's hemodynamic status. Secondary outcomes included transfusion requirements, complications, and length of hospital stay. RESULTS: All 11 patients underwent hysterectomy for postpartum hemorrhage and subsequently required abdominal packing due to persistent bleeding. The median age was 33 years, and the median gravidity was 3. The primary causes of postpartum hemorrhage were uterine atony (54.5%), placenta previa (36.4%), and disseminated intravascular coagulation (9.1%). The median number of packs used was 3, and packs were removed after 24 hours in all cases. Abdominal packing successfully controlled persistent bleeding in all patients following hysterectomy. The median length of hospital stay was 6 days. All patients required blood transfusions. The most common complication was pulmonary edema (90.9%). All patients survived. CONCLUSION: Abdominal packing may serve as a valuable temporary rescue measure for severe, refractory obstetric hemorrhage in selected cases where conventional methods are insufficient. Careful patient selection and close postoperative monitoring are essential.