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Uterine packing with chitosan-covered gauze for control of postpartum hemorrhage

Bernd C. Schmid, MD , Günther A. Rezniczek, PhD , Norbert Rolf, MD , George Saade, MD , Gerhard Gebauer, MD , Holger Maul, MD

American Journal of Obstetrics and Gynecology, Volume 209, Issue 3, September 2013, Pages 225.e1–225.e5

Editor’s comment: Prof. Jim Thornton: Chitosan-covered gauze packing to treat postpartum haemorrhage
Chitosan is a hydrophilic biopolymer prepared from chitin, a component of crustacean shells, which provokes clotting by electrostatic interaction with erythrocyte cell membranes. This mechanism is said to be independent of the classical coagulation pathway. This paper describes the successful use of chitosan-covered gauze packing to treat major postpartum haemorrhage in 19 women. Hysterectomy was avoided in all but one.

Abstract

Objective

To describe the use of gauze covered with chitosan, a potent hemostatic agent derived from chitin, in the treatment of postpartum hemorrhage (PPH).

Study Design

Patients suffering from postpartum hemorrhage were treated by uterine packing with chitosan-covered gauze, either through the hysterotomy in case of cesarean delivery or transvaginally, for up to 24 hours.

Results

Chitosan-covered gauze was used in 19 cases of postpartum hemorrhage due to uterine atony, placenta accreta/increta, or anticoagulation, including 5 severe cases where a hysterectomy seemed inevitable otherwise. In all but one case, the bleeding stopped and further interventions were avoided. Over comparable periods of time (18 months) and births (3822 vs 4077) before and after the introduction of the chitosan gauze in our clinic, the rate of peripartum hysterectomies was reduced by 75% (8 vs 2; odds ratio, 4.27; P = .044).

Conclusion

Chitosan-covered gauze is a viable option in the treatment of (severe) postpartum hemorrhage. It is easy to use and requires no special training. It can be used after both vaginal and cesarean deliveries, and there are no adverse side effects. Furthermore, it is very inexpensive compared with other treatment options, making it suitable for use also in low resource-countries, where the death toll due to postpartum hemorrhage is especially high.

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Commentaries by Editor Prof. Jim Thornton