Intrauterine tamponade with chitosan-covered gauze for managing postpartum hemorrhage
- Autores: Shalina R.I.1, Breslav I.Y.1, Fedorets A.V.1, Znaenko R.B.2, Morozov V.A.2, Novailova T.S.2
-
Afiliações:
- N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia
- V.I. Vernadsky Crimean Federal University
- Edição: Nº 12 (2024)
- Páginas: 5-10
- Seção: Reviews
- URL: https://journals.eco-vector.com/0300-9092/article/view/651718
- DOI: https://doi.org/10.18565/aig.2024.294
- ID: 651718
Citar
Texto integral



Resumo
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.
Texto integral

Sobre autores
Raisa Shalina
N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia
Email: shalina_ri@rsmu.ru
ORCID ID: 0000-0001-7121-1663
Dr. Med. Sci., Professor, Department of Obstetrics and Gynecology named after Academician G.M. Savelyeva IMC
Rússia, Moscow, Ostrovityanov str., 1Irina Breslav
N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia
Email: irina_breslav@mail.ru
ORCID ID: 0000-0002-0245-4968
Dr. Med. Sci., Professor, Department of Obstetrics and Gynecology named after Academician G.M. Savelyeva IMC
Rússia, Moscow, Ostrovityanov str., 1Alina Fedorets
N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia
Autor responsável pela correspondência
Email: alinka_fedorec96@mail.ru
ORCID ID: 0000-0001-6079-1527
Resident at the Department of Obstetrics and Gynecology named after Academician G.M. Savelyeva IMC
Rússia, Moscow, Ostrovityanov str., 1Ruslan Znaenko
V.I. Vernadsky Crimean Federal University
Email: qazplw65@gmail.com
ORCID ID: 0009-0006-3502-280X
Student at the Department of Obstetrics, Gynecology and Perinatology No. 1, S.I. Georgievsky Medical Institute
Rússia, 295051, Republic of Crimea, Simferopol, Lenin Blvd., 5/7Vladimir Morozov
V.I. Vernadsky Crimean Federal University
Email: vladimir.morozzzov@inbox.ru
ORCID ID: 0009-0007-1961-3965
Student at the Department of Obstetrics, Gynecology and Perinatology No. 1, S.I. Georgievsky Medical Institute
Rússia, 295051, Republic of Crimea, Simferopol, Lenin Blvd., 5/7Tatyana Novailova
V.I. Vernadsky Crimean Federal University
Email: tania_ivankina@mail.ru
ORCID ID: 0009-0009-8450-4620
Student at the Department of Obstetrics, Gynecology and Perinatology No. 1, S.I. Georgievsky Medical Institute
Rússia, 295051, Republic of Crimea, Simferopol, Lenin Blvd., 5/7Bibliografia
- WHO. Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and the UNDESA/Population Division. Available at: https://www.who.int/publications/i/item/9789240068759
- Jaffer D., Singh P.M., Aslam A., Cahill A.G., Palanisamy A., Monks D.T. Preventing postpartum hemorrhage after cesarean delivery: a network meta-analysis of available pharmacologic agents. Am. J. Obstet. Gynecol. 2022; 226(3): 347-65. https://dx.doi.org/10.1016/j.ajog.2021.08.060.
- WHO. Maternal mortality. Available at: https://www.who.int/news-room/fact-sheets/detail/maternal-mortality
- Kramer M.S., Berg C., Abenhaim H., Dahhou M., Rouleau J., Mehrabadi A. et al. Incidence, risk factors, and temporal trends in severe postpartum hemorrhage. Am. J. Obstet. Gynecol. 2013; 209(5): 449.e1-449.e4497. https://dx.doi.org/10.1016/j.ajog.2013.07.007.
- Bellos I., Pergialiotis V. Tranexamic acid for the prevention of postpartum hemorrhage in women undergoing cesarean delivery: an updated meta-analysis. Am. J. Obstet. Gynecol. 2022; 226(4): 510-23.e22. https://dx.doi.org/10.1016/j.ajog.2021.09.025.
- Bateman B.T., Mhyre J.M., Callaghan W.M., Kuklina E.V. Peripartum hysterectomy in the United States: nationwide 14 year experience. Am. J. Obstet. Gynecol. 2012; 206(1): 63.e1-63.e638. https://dx.doi.org/10.1016/j.ajog.2011.07.030.
- Курцер М.А., Бреслав И.Ю., Коноплев Б.А., Коноплянников А.Г. Эмболизация маточных артерий в терапии послеродовых гипотонических кровотечений. Журнал им. Н.В. Склифосовского «Неотложная медицинская помощь». 2022; 11(4): 637-44. [Kurtser M.A., Breslav I.Yu., Konoplyov B.A., Konoplyannikov A.G. Uterine artery embolization in the treatment of postpartum hypotonic bleeding. Russian Sklifosovsky Journal "Emergency Medical Care". 2022; 11(4): 637-44. (in Russian)]. https://dx.doi.org/10.23934/2223-90222022-11-4-637-644.
- Bennett B.L., Littlejohn L. Review of new topical hemostatic dressings for combat casualty care. Mil. Med. 2014; 179(5): 497-514. https://dx.doi.org/10.7205/MILMED-D-13-00199.
- Waibel K.H., Haney B., Moore M., Whisman B., Gomez R. Safety of chitosan bandages in shellfish allergic patients. Mil. Med. 2011; 176(10): 1153-6. https://dx.doi.org/10.7205/milmed-d-11-00150.
- Rao S.B., Sharma C.P. Use of chitosan as a biomaterial: studies on its safety and hemostatic potential. J. Biomed. Mater. Res. 1997; 34(1): 21-8. https://dx.doi.org/10.1002/(sici)1097-4636(199701)34:1<21::aid-jbm4>3.0.co;2-p.
- Pellis A., Guebitz G.M., Nyanhongo G.S. Chitosan: sources, processing and modification techniques. Gels. 2022; 8(7): 393. https://dx.doi.org/10.3390/gels8070393.
- Aiba S. Studies on chitosan: 4. Lysozymic hydrolysis of partially N-acetylated chitosans. Int. J. Biol. Macromol. 1992; 14(4): 225-8. https://dx.doi.org/10.1016/s0141-8130(05)80032-7.
- Carles G., Dabiri C., Mchirgui A., Saoudi E.O., Hcini N., Pouget K. et al. Uses of chitosan for treating different forms of serious obstetrics hemorrhages. J. Gynecol. Obstet. Hum. Reprod. 2017; 46(9): 693-5. https://dx.doi.org/10.1016/j.jogoh.2017.08.003.
- Schmid B.C., Rezniczek G.A., Rolf N., Saade G., Gebauer G., Maul H. Uterine packing with chitosan-covered gauze for control of postpartum hemorrhage. Am. J. Obstet. Gynecol. 2013; 209(3): 225.e1-225.e2255. https://dx.doi.org/10.1016/j.ajog.2013.05.055.
- Kean T., Thanou M. Biodegradation, biodistribution and toxicity of chitosan. Adv. Drug Deliv. Rev. 2010; 62(1): 3-11. https://dx.doi.org/10.1016/j.addr.2009.09.004.
- Kheirabadi B.S., Edens J.W., Terrazas I.B., Estep J.S., Klemcke H.G., Dubick M.A. et al. Comparison of new hemostatic granules/powders with currently deployed hemostatic products in a lethal model of extremity arterial hemorrhage in swine. J. Trauma. 2009; 66(2): 316-28. https://dx.doi.org/10.1097/TA.0b013e31819634a1.
- Clay J.G., Grayson J.K., Zierold D. Comparative testing of new hemostatic agents in a swine model of extremity arterial and venous hemorrhage. Mil. Med. 2010; 175(4): 280-4. https://dx.doi.org/10.7205/milmed-d-09-00185.
- Rall J.M., Cox J.M., Songer A.G., Cestero R.F., Ross J.D. Comparison of novel hemostatic dressings with QuikClot combat gauze in a standardized swine model of uncontrolled hemorrhage. J. Trauma Acute Care Surg. 2013; 75(2 Suppl 2): S150-S156. https://dx.doi.org/10.1097/TA.0b013e318299d909.
- Kozen B.G., Kircher S.J., Henao J., Godinez F.S., Johnson A.S. An alternative hemostatic dressing: comparison of CELOX, HemCon, and QuikClot. Acad. Emerg. Med. 2008; 15(1): 74-81. https://dx.doi.org/10.1111/j.1553-2712.2007.00009.x.
- Pusateri A.E., Holcomb J.B., Kheirabadi B.S., Alam H.B., Wade C.E., Ryan K.L. Making sense of the preclinical literature on advanced hemostatic products. J. Trauma. 2006; 60(3): 674-82. https://dx.doi.org/10.1097/01.ta.0000196672.47783.fd.
- Winstanley M., Smith J.E., Wright C. Catastrophic haemorrhage in military major trauma patients: a retrospective database analysis of haemostatic agents used on the battlefield. J. R. Army Med. Corps. 2019; 165(6): 405-9. https://dx.doi.org/10.1136/jramc-2018-001031.
- Pozza M., Millner R.W. Celox (chitosan) for haemostasis in massive traumatic bleeding: experience in Afghanistan. Eur. J. Emerg. Med. 2011; 18(1): 31-3. https://dx.doi.org/10.1097/MEJ.0b013e32833a5ee4.
- Arul G.S., Bowley D.M., DiRusso S. The use of Celox gauze as an adjunct to pelvic Packing in otherwise uncontrollable pelvic haemorrhage secondary to penetrating trauma. J. R. Army Med. Corps. 2012; 158(4): 331-4. https://dx.doi.org/10.1136/jramc-158-04-12.
- Bennett B.L., Littlejohn L.F., Kheirabadi B.S., Butler F.K. Jr., Kotwal R.S., Dubick M.A. et al. Management of external hemorrhage in tactical combat casualty care: chitosan-based hemostatic gauze dressings--TCCC Guidelines-Change 13-05. J. Spec. Oper. Med. 2014; 14(3): 40-57. https://dx.doi.org/10.55460/03VO-8FLO.
- Schmid B.C., Rezniczek G.A., Rolf N., Maul H. Postpartum hemorrhage: use of hemostatic combat gauze. Am. J. Obstet. Gynecol. 2012; 206(1): e12-e13. https://dx.doi.org/10.1016/j.ajog.2011.09.018.
- Schmid B.C., Rezniczek G.A., Rolf N., Saade G., Gebauer G., Maul H. Uterine packing with chitosan-covered gauze for control of postpartum hemorrhage. Am. J. Obstet. Gynecol. 2013; 209(3): 225.e1-225.e2255. https://dx.doi.org/10.1016/j.ajog.2013.05.055.
- Carles G., Dabiri C., Mchirgui A., Saoudi E.O., Hcini N., Pouget K. et al. Uses of chitosan for treating different forms of serious obstetrics hemorrhages. J. Gynecol. Obstet. Hum. Reprod. 2017; 46(9): 693-5. https://dx.doi.org/10.1016/j.jogoh.2017.08.003.
- Dueckelmann A.M., Hinkson L., Nonnenmacher A., Siedentopf J.P., Schoenborn I., Weizsaecker K. et al. Uterine packing with chitosan-covered gauze compared to balloon tamponade for managing postpartum hemorrhage. Eur. J. Obstet. Gynecol. Reprod. Biol. 2019; 240: 151-5. https://dx.doi.org/10.1016/j.ejogrb.2019.06.003.
- Biele C., Radtke L., Kaufner L., Hinkson L., Braun T., Henrich W. et al. Does the use of chitosan covered gauze for postpartum hemorrhage reduce the need for surgical therapy including hysterectomy? A databased historical cohort study. J. Perinat. Med. 2022; 50(8):1078-86. https://dx.doi.org/10.1515/jpm-2021-0533.
- Михайлов А.В., Кузнецов А.А., Шман В.В. Первый опыт использования гемостатической ленты с хитозаном в целях остановки послеродового кровотечения. В кн.: Сухих Г.Т., Серов В.Н., ред. Сборник тезисов XXV Юбилейного Всероссийского научно-образовательного форума «Мать и Дитя - 2024». Москва, 1-3 октября 2024 г. М.; 2024: 56-7. [Mikhailov A.V., Kuznetsov A.A., Shman V.V. The first experience of using a hemostatic tape with chitosan to stop postpartum bleeding. In: Sukhikh G.T., Serov V.N., eds. Collection of abstracts of the XXV Anniversary All-Russian Scientific and Educational Forum "Mother and Child - 2024". Moscow, October 1-3, 2024. Moscow; 2024: 56-7. (in Russian)].
Arquivos suplementares
