Background: Massive obstetrical hemorrhage can be catastrophic, with considerable morbidity and mortality, and it is the single most important cause of maternal death worldwide. Case: A 36-year-old woman developed uterine atonia, for which subtotal hysterectomy and bilateral internal iliac artery ligation were performed. After the surgery, she was taken to the intensive care unit (ICU) for major hemorrhage shock, acidosis, hypothermia, and coagulopathy. A new laparotomy showed 3 L of hemoperitoneum and active bleeding from the hysterectomy site; this bleeding was controlled by intraabdominal packing and temporary abdominal closure. Once the patient showed signs of improvement, a scheduled reoperative procedure was performed to remove the packs, and provide definitive abdominal closure. The patient stayed in the ICU for 3 days. Results: This patient's vital signs and results of laboratory studies improved, and she had no evidence of further intraabdominal bleeding. She was discharged to go home on postoperative day 10 with her healthy newborn. Both the mother and her newborn remained well at follow-up. Conclusions: The damage-control technique has been shown to increase overall survival and is likely to modify management of critically injured patients. Simplicity is the key in damage control. The damage-control concept may offer an option to optimize management of patients with life-threatening postpartum hemorrhaging (PPH). (J GYNECOL SURG 30:230)
American College of Obstetrics and Gynecologists. ACOG Practice Bulletin: Clinical Management Guidelines for Obstetrician-Gynecologists Number 76, October 2006. Postpartum hemorrhage. Obstet Gynecol, 2006; 108:1039.
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KeriakosR, ChaudhuriS. Operative interventions in the management of major postpartum haemorrhage. J Obstet Gynaecol, 2012; 32:14.
