Pelvic umbrella pack for refractory obstetric hemorrhage secondary to posterior uterine rupture

BACKGROUND: Pelvic hemorrhage continues to be a serious complication of pregnancy and can lead to significant maternal morbidity. The pelvic umbrella pack is a useful alternative to control pelvic bleeding when standard measures fail. CASE: A patient with a previous low transverse cesarean delivery presented in active labor at term. After an uneventful vaginal delivery, defects in the posterior vaginal wall and lower uterine segment were identified. A hysterectomy with repair of the vaginal laceration was performed, but diffuse bleeding persisted. After routine surgical techniques failed to achieve adequate hemostasis, a pelvic umbrella pack was successfully used to tamponade pelvic bleeding. CONCLUSION: In the event of continued hemorrhage after hysterectomy, bleeding that is uncontrolled by surgical intervention may be controlled with a pelvic umbrella pack. (C) 2002 by The American College of Obstetricians and Gynecologists.