[Padding of the uterine wall in severe obstetrical hemorrhage]

Severe obstetrical hemorrhage demand an emergency treatment, and hysterectomy is not always adequate. We report our technique of uterine wall padding (UWP), as performed on five women who underwent surgery with UWP for an obstetrical hemorrhage that was severe either at the onset (n = 3) or after transfer to our department (n = 2). The technique consists of padding the uterine walls with X stitches of slowly resorbable thread. The reasons for the operation were: uterine muscle atonia in 2 cases and vaginal laceration, placenta preavia and placenta accreta in 1 case each. The UWP technique was carried out during or after subtotal hysterectomy for hemorrhage in 4 patients, and with preservation of the uterus in one patient. No secondary operation was required after UWP. Less blood products were transfused in women who had immediate UWP than in those for whom UWP was a second-line operation. UWP was more efficient when performed at an early stage. In the woman with placenta accreta the uterus could be salvaged by UWP. This simple technique contributes to the reduction of blood transfusions in severe obstetrical hemorrhage.