Intrauterine tamponade with chitosan-covered gauze for managing postpartum hemorrhage

DOI

https://dx.doi.org/10.18565/aig.2024.294

Shalina R.I., Breslav I.Yu., Fedorets A.V., Znaenko R.B., Morozov V.A., Novailova T.S.
1) N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia; 2) S.I. Georgievsky Medical Institute, V.I. Vernadsky Crimean Federal University, Simferopol, Russia

Severe postpartum hemorrhage is responsible for significant maternal mortality and morbidity worldwide. The traditional use of uterotonics (oxytocin, prostaglandins) and medications for maintaining coagulation (fibrinogen and tranexamic acid) is not always effective and may not be sufficient to control life-threatening postpartum hemorrhage. Severe postpartum hemorrhage leads to an increased need for blood transfusion and the use of invasive techniques such as intrauterine balloon tamponade, compression sutures and artery ligation, which are important steps in treatment. In extreme cases, hysterectomy may be required to avoid possible maternal death. Intrauterine tamponade with chitosan-covered gauze is a novel technique in the arsenal of the obstetric team, especially when resources for surgical intervention and other invasive methods may be limited.
The modified gauze was initially developed for the management of acute bleeding in military medicine. It combines the physiological anti-hemorrhagic effect of modified chitosan with compression tamponade and is used to treat acute wound bleeding. The first description of the use of gauze with chitosan in obstetrics dates back to 2012; it showed that tamponade with chitosan-covered gauze is an effective means of controlling postpartum hemorrhage that is resistant to conventional therapy. Further research has demonstrated a reduction in the rates of hysterectomy and blood transfusion. However, this technique is not sufficiently presented in the literature and is not commonly used yet.
Conclusion: Intrauterine tamponade with chitosan-covered gauze is a novel adjunctive method in the management of severe uterine hemorrhage, especially in places where resources for advanced surgical techniques and other invasive therapies may be limited. In order to put this technique into practice, it is necessary to conduct a prospective, multicenter, randomized, placebo-controlled study to determine the effectiveness of tamponade with chitosan-covered gauze in severe obstetric hemorrhage.

Authors’ contributions: Shalina R.I., Breslav I.Yu. – editing the article; Fedorets A.V. – developing the concept of the study, collecting and processing the material, writing the text; Znaenko R.B. – writing the text; Morozov V.A. – collecting and processing the material, writing the text; Novailova T.S. – collecting and processing the material.
Conflicts of interest: The authors declare that there are no conflicts of interest.
Funding: The study was carried out without sponsorship.
For citation: Shalina R.I., Breslav I.Yu., Fedorets A.V., Znaenko R.B., Morozov V.A., Novailova T.S.
Intrauterine tamponade with chitosan-covered gauze for managing postpartum hemorrhage.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; (12): 5-10 (in Russian)
https://dx.doi.org/10.18565/aig.2024.294

chitosan-covered gauze

coagulation

intrauterine tamponade

postpartum hysterectomy

severe postpartum hemorrhage

hypotonic hemorrhage

Full text (in Russian)

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Received 19.11.2024

Accepted 28.11.2024

Raisa I. Shalina, Dr. Med. Sci., Professor, Department of Obstetrics and Gynecology named after Academician G.M. Savelyeva IMC, N.I. Pirogov RNRMU, Ministry of Health of Russia, 117513, Russia, Moscow, Ostrovityanov str., 1, +7(495)718-34-72, shalina_ri@rsmu.ru, https://orcid.org/0000-0001-7121-1663
Irina Yu. Breslav, Dr. Med. Sci., Professor, Department of Obstetrics and Gynecology named after Academician G.M. Savelyeva IMC, N.I. Pirogov RNRMU, Ministry of Health of Russia, 117513, Russia, Moscow, Ostrovityanov str., 1, +7(495)719-78-96, irina_breslav@mail.ru, https://orcid.org/0000-0002-0245-4968
Alina V. Fedorets, Resident at the Department of Obstetrics and Gynecology named after Academician G.M. Savelyeva IMC, Pirogov RNRMU, Ministry of Health of Russia, 117513, Russia, Moscow, Ostrovityanov str., 1, +7(978)721-74-67, alinka_fedorec96@mail.ru, https://orcid.org/0000-0001-6079-1527
Ruslan B. Znaenko, Student at the Department of Obstetrics, Gynecology and Perinatology No. 1, Medical Institute named after S.I. Georgievsky, V.I. Vernadsky CFU,
295051, Republic of Crimea, Simferopol, Lenin Blvd., 5/7, +7(978)816-06-47, qazplw65@gmail.com, https://orcid.org/0009-0006-3502-280X
Vladimir A. Morozov, Student at the Department of Obstetrics, Gynecology and Perinatology No. 1, Medical Institute named after S.I. Georgievsky, V.I. Vernadsky CFU, 295051, Republic of Crimea, Simferopol, Lenin Blvd., 5/7, +7(978)962-02-83, vladimir.morozzzov@inbox.ru, https://orcid.org/0009-0007-1961-3965
Tatyana S. Novailova, Student at the Department of Obstetrics, Gynecology and Perinatology No. 1, Medical Institute named after S.I. Georgievsky, V.I. Vernadsky CFU, 295051, Republic of Crimea, Simferopol, Lenin Blvd., 5/7, +7(978)599-62-13, tania_ivankina@mail.ru, https://orcid.org/0009-0009-8450-4620
Corresponding author: Alina V. Fedorets, alinka_fedorec96@mail.ru

Intrauterine tamponade with chitosan-covered gauze for managing postpartum hemorrhage

Shalina R.I., Breslav I.Yu., Fedorets A.V., Znaenko R.B., Morozov V.A., Novailova T.S.

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