Intrauterine tamponade with chitosan-covered gauze for managing postpartum hemorrhage

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.