A THROMBOGENIC UTERINE PACK FOR POSTPARTUM HEMORRHAGE

Background: A low-lying placenta or placenta previa is frequently asso ciated with postpartum hemorrhage from a low implantation site. We des cribe the successful use of a thrombin-soaked uterine pack for this co ndition. Case: A 30-year-old woman, gravida 3, para 0-0-2-0, had place nta previa diagnosed by ultrasound at 26 weeks' gestation. A repeat ex amination at 35 weeks demonstrated a low-lying placenta. The patient h ad an uncomplicated intrapartum course and was delivered by vacuum ext raction, but excessive vaginal bleeding was noted 3 hours after sponta neous delivery of the placenta. Oxytocin, prostaglandin, and uterine c urettage failed to control the hemorrhage. In an attempt to avoid lapa rotomy, we placed a thrombin-soaked uterine pack over the bleeding sit e. There was minimal vaginal bleeding during the following 8 hours, so the pack was removed. The patient had no further complications and wa s released 3 days after delivery. Conclusion: A thrombin-soaked uterin e pack may successfully control lower uterine segment bleeding followi ng delivery of a patient with a low-lying placenta. This technique off ers the obstetrician another treatment option in selected cases of pos tpartum hemorrhage.