Abdominal Packing for Obstetric Surgical Uncontrollable Hemorrhage

Postpartum hemorrhage (PPH), which makes up the bulk of the 14 million occurrences of obstetric hemorrhage that happen yearly, is the most prevalent type. Obstetric emergencies must be promptly identified and treated because most PPH-related deaths occur within four hours of delivery and even after hysterectomy. This literature study tries to elucidate abdominal packing in reducing obstetrical bleeding in greater detail. Pads or roller gauze (sterile pads bound by suture threads, wrapped in a sterile bag, or stacked gauze) and balloon pack (Foley catheter or Bakri balloon), and abdominal packs retrieved within 24-48 hours, are two categories of abdominal packing techniques for controlling bleeding after hysterectomy. Due to its ease of use, minimal risk of complications, and usefulness in environments with limited resources, abdominal packing continues to be a valuable technique in the arsenal of the modern obstetrician.

Is the Whole Greater Than the Sum of Its Parts? The Implementation and Outcomes of a Whole Blood Program in Ecuador

Background: Hemorrhagic shock is a major cause of mortality in low-and-middle-income countries (LMICs). Many institutions in LMICs lack the resources to adequately prescribe balanced resuscitation. This study aims to describe the implementation of a whole blood program in Latin America and discuss the outcomes of the patients that received whole blood (WB).

Methods: We conducted a retrospective review of patients resuscitated with WB from 2013-2019. Five units of O+ WB were made available on a consistent basis for patients presenting in hemorrhagic shock. Variables collected included: sex, age, service treating the patient, units of WB administered, units of components administered, admission vital signs, admission hemoglobin, Shock Index, intraoperative crystalloid and colloid administration, symptoms of transfusion reaction, length-of-stay and in-hospital mortality.

Results: The sample includes a total of 101 patients, 57 of whom were trauma and acute care surgery (TACS) patients and 44 of whom were obstetrics and gynecology patients. No patients developed symptoms consistent with a transfusion reaction. Average shock index was 1.16 (±0.55). On average, patients received 1.66 (±0.80) units of whole blood. Overall mortality was 14/101 (13.86%) in the first 24 hours and 6/101 (5.94%) after 24 hours.

Conclusion: Implementing a WB protocol is achievable in LMICs. Whole blood allows for more efficient delivery of hemostatic resuscitation and is ideal for resource-restrained settings. To our knowledge, this is the first description of a whole blood program implemented in a civilian hospital in Latin America.