An effective pressure pack for severe pelvic hemorrhage

Obstet Gynecol. 2006 Nov;108(5):1222-6. doi: 10.1097/01.AOG.0000241098.11583.a4.


Objective: To evaluate our experience with the "pelvic pressure pack," a surgical technique for controlling posthysterectomy bleeding.

Methods: This is an observational descriptive report of cases collected by the authors during the years 1968-2006. Packs were constructed of various materials (eg, pillow cases, gauze sheets, plastic X-ray cassette drapes, or orthopedic stockings) filled with gauze rolls introduced abdominally and exiting the vagina.

Results: We report 11 new cases (10 obstetric and one gynecologic). Massive red blood cell transfusion and coagulopathy occurred in all cases. The pelvic pressure pack successfully controlled bleeding in 82% (9 of 11) of cases. Postoperative febrile morbidity occurred in most cases. There were no maternal deaths.

Conclusion: In the contemporary management of posthysterectomy bleeding, the pelvic pressure pack appears to be a valuable surgical option, affording correction of coagulopathy and further stabilization. Given near-universal postoperative febrile morbidity in our series, prophylactic broad-spectrum antibiotic therapy should be strongly considered. We believe all obstetrician-gynecologists should be familiar with this simple, potentially life-saving technique.

Level of evidence: III.

MeSH terms

  • Adult
  • Bandages*
  • Erythrocyte Transfusion
  • Female
  • Hemostatic Techniques*
  • Humans
  • Hysterectomy / adverse effects*
  • Middle Aged
  • Postoperative Complications / therapy*
  • Pregnancy
  • Pregnancy Complications / surgery
  • Pressure
  • Retrospective Studies
  • Uterine Hemorrhage / etiology
  • Uterine Hemorrhage / therapy*