ABSTRACT
Some obstetric centers have adopted gravimetric methods for quantifying blood loss, including weighing of pads and sponges and the use of calibrated under-buttock drapes. One study demonstrated that visual assessment of blood loss underestimated that calculated by weighing of pads and sponges by approximately 30%. Advantages of the uterine balloon include simplicity and minimal requirement for local resources and training. Alternative uterine tamponade techniques have recently shown promising observational data. Massive hemorrhage may exceed the clinical care team’s ability to “keep up,” leading to hemodynamic instability and shock frequently in the presence of acidosis, hypothermia, and coagulopathy. Damage control surgery during obstetrics is defined as abdominopelvic packing. After packing, coagulopathy can be corrected and interventional radiology can be utilized if the patient is stable and if it is available. The rationale was that stimulating uterine contractions with oxytocin or prostaglandins, or cervical relaxation with nitroglycerin, would facilitate spontaneous placental delivery and avoid further invasive interventions.
