Accreta Ready: Mastering Abdominopelvic Packing for Crisis Situations.

Abstract

Although diffuse, ongoing bleeding due to refractory coagulopathy is not frequently encountered in obstetric surgery, patients with placenta accreta spectrum undergoing cesarean hysterectomy are at uniquely high risk for this occurrence. Therefore, obstetrician-gynecologists (ob-gyns) should be familiar with strategies to manage these rare but critical surgical situations. Abdmoinopelvic packing, a surgical technique in which the bowel is protected with a plastic drape before the peritoneal cavity is pressure-packed with laparotomy sponges and, finally, adhesive tape and sump drains are used to create negative pressure in the packed space, can be a lifesaving tool in the management of coagulopathy in the setting of catastrophic hemorrhage. To better prepare ob-gyns to perform abdominopelvic packing, we created an innovative, low-fidelity, low-cost simulation, which we demonstrate in Video 1 .