| Abstrakt: |
1.1. Various types of uterine packing have been reviewed, either plain or impregnated with some chemical. Likewise, various means of introducing the pack within the uterus have been described.2.2. The sole purpose of the uterine pack is to control bleeding in the atonic uterus after other means have been used as oxytocics.3.3. Delay in the use of the uterine tamponade very often results in a fatality.4.4. The introduction of any foreign object into the uterus increases the incidence of infection. The withdrawal of the uterine pack produces a curettage-like action at the time when the uterine cavity is teeming with bacteria.5.5. The purpose of the use of sulfanilamide impregnated gauze packs is prophylactic against infection because of the bacteriostatic action of the drug at the site of contact with tissue.6.6. The technique of impregnating the gauze pack with sulfanilamide is described and discussed.7.7. The use of a small cotton ball, encased within the meshes of the uterine pack, serves as a very satisfactory means of obtaining both aerobic and anaerobic intrauterine cultures.8.8. In our judgment, grasping the anterior and posterior lips of the cervix with ring forceps, thereby bringing the cervix directly into view, and snugly introducing the gauze into the uterine cavity by means of a third ring forceps is the most acceptable manner of packing the uterus.9.9. There is a general diminution in the number and kinds of bacteria in general, and of the hemolytic streptococci and Staphylococcus aureusin particular, when sulfanilamide is used to impregnate the intrauterine pack. Clinically, the plain pack, used as an intrauterine tamponade, increases morbidity above that of either the sulfanilamide or iodoform pack.10.10. This preliminary series is small, from a bacteriologic standpoint, and a larger number of cases is desirable before definite conclusions are drawn. However, from the fact that sulfanilamide gives a much more sanitary pack, tends to decrease the bacterial flora, inhibits growth of hemolytic streptococci, and is absorbed to a limited degree into the blood stream, it seems advisable to use sulfanilamide packs in preference to either plain or iodoform, when indicated. |
