Jemds.com Original Research Article J. Evolution Med. Dent. Sci./eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 8/ Issue 27/ July 08, 2019 Page 2162 UTEROVAGINAL PACKING WITH ROLLED GAUZE IN POST-PARTUM HAEMORRHAGE, A RETROSPECTIVE STUDY IN MALDA MEDICAL COLLEGE, WEST BENGAL Malay Sarkar 1 , Jaydeb Mandal 2 , Dibyendu Roy 3 1 Associate Professor, Department of Obstetrics and Gynaecology, Malda Medical College and Hospital, Malda, West Bengal, India. 2 Assistant Professor, Department of Obstetrics and Gynaecology, Malda Medical College and Hospital, Malda, West Bengal, India. 3 RMO-Cum-Clinical Tutor, Department of Obstetrics and Gynaecology, Malda Medical College and Hospital, Malda, West Bengal, India. ABSTRACT BACKGROUND Post-Partum Haemorrhage (PPH) is one of the five leading causes of maternal death in the developed and developing countries. PPH less than up to 1000 ml is well tolerated by a healthy pregnant woman particularly due to physiological increase in the plasma and the red cell mass during pregnancy. We wanted to determine efficacy of uterovaginal packing and its sequelae in low resource settings. METHODS After ethical committee permission and informed patient consent, a four-year retrospective study was conducted in the department of Obstetrics and Gynaecology of Malda Medical College, West Bengal, India. Total number of vaginal deliveries was 41990 in last four years (2014-2018). Total fifty-three (n-53) cases of primary PPH following vaginal deliveries who were hemodynamically stable after initial resuscitation with crystalloid and blood but unresponsive to bimanual compression and medical therapy were managed with uterovaginal packing for 24 hours. Traumatic PPH, PPH due to retained placental tissue or PPH following caesarean deliveries were excluded. RESULTS Out of fifty-three (53) cases, PPH was arrested in forty-eight (48) cases only five (5) cases required further surgical therapy. Combined utero-ovarian artery ligation (quadruple ligation) was done in one patient, and two patients responded to bilateral internal iliac artery ligation (BIIL) or hypogastric artery ligation (HAL). Two patients needed peri partum hysterectomies they continued to lose blood in spite of all conservative uterus saving methods. CONCLUSIONS Uterovaginal packing is a convenient and effective procedure for controlling intractable PPH if detected and managed promptly, when patient is hemodynamically stable. It is very much effective procedure in low resource setting particularly in rural India. Based on our study 90% of woman responded to utero vaginal roller gauze packing. In life threatening haemorrhage uterine packing will not only halt the blood loss and preserve the uterus but also gives an opportunity to reverse and correct any consumptive coagulopathy. By using the uterine roller packing one would expect the total blood loss to be reduced and blood products are avoided. Every obstetrician must be familiar with this simple method in order to avoid having to perform a hysterectomy and preserving the reproductive capability as well as diminishing the operative morbidity and mortality. Uterovaginal packing is a useful technique for control of post-partum haemorrhage in any set up with low resource setting. It is simple, easy technique requiring less skill which can be taught easily to the trainee residents. KEY WORDS Bilateral Hypogastric Artery Ligation, Hysterectomy, Hemodynamic Status, PPH, Quadruple Ligation, Uterovaginal Packing, Roller Gauze HOW TO CITE THIS ARTICLE: Sarkar M, Mandal J, Roy D. Uterovaginal packing with rolled gauze in post-partum haemorrhage, a retrospective study in Malda medical college, West Bengal. J. Evolution Med. Dent. Sci. 2019;8(27):2162-2165, DOI: 10.14260/jemds/2019/474 BACKGROUND Primary PPH is one of the five most common causes of maternal mortality in the developed and developing countries. 1 PPH less than up to 1000 ml is well tolerated by a healthy pregnant woman particularly due to physiological increase in ‘Financial or Other Competing Interest’: None. Submission 14-02-2019, Peer Review 11-04-2019, Acceptance 17-04-2019, Published 08-07-2019. Corresponding Author: Dr. Dibyendu Roy, Vill+PO+PS-Minakhan-743425, North 24 Parganas, West Bengal, India. E-mail: dibyendulive@gmail.com DOI: 10.14260/jemds/2019/474 the plasma and the red cell mass during pregnancy. PPH is responsible for an annual mortality of 150000 women/year. 2 Leading cause of PPH is uterine atony in >90% of cases. Whereas genital tract trauma, retained product of conception and coagulopathy are the other causes. PPH is an obstetric emergency which requires prompt diagnosis and effective action to prevent maternal mortality 3 . PPH occurring in first 24 hours following delivery is called primary PPH, and PPH occurring after 24 hours but up to 12 weeks is called secondary PPH. California maternal quality care collaborative obstetric haemorrhage protocol describes the following stages of PPH. Stage 0: Blood loss <500 ml in vaginal delivery and < 1000 ml in caesarean delivery with stable vital sign. Stage 1: Blood loss > 500 ml with vaginal delivery or >1000 ml with caesarean delivery or change in vital sign >15% or HR