A thrombogenic uterine pack for postpartum hemorrhage.

Abstract

A low-lying placenta or placenta previa is frequently associated with postpartum hemorrhage from a low implantation site. We describe the successful use of a thrombin-soaked uterine pack for this condition. A 30-year-old woman, gravida 3, para 0-0-2-0, had placenta previa diagnosed by ultrasound at 26 weeks' gestation. A repeat examination at 35 weeks demonstrated a low-lying placenta. The patient had an uncomplicated intrapartum course and was delivered by vacuum extraction, but excessive vaginal bleeding was noted 3 hours after spontaneous delivery of the placenta. Oxytocin, prostaglandin, and uterine curettage failed to control the hemorrhage. In an attempt to avoid laparotomy, we placed a thrombin-soaked uterine pack over the bleeding site. There was minimal vaginal bleeding during the following 8 hours, so the pack was removed. The patient had no further complications and was released 3 days after delivery. A thrombin-soaked uterine pack may successfully control lower uterine segment bleeding following delivery of a patient with a low-lying placenta. This technique offers the obstetrician another treatment option in selected cases of postpartum hemorrhage.