Chitosan Tamponade in the Management of Acute Postpartum Hemorrhage

Bodog Alin, Anca Huniadi, Beres Zsolt, Danciu-Bostan Adela, Ivan Teodora, Vancea-Pipa Larisa Evelina, Eloreibi El Rachid 

1 Departmant of surgical discipline, Faculty of Medicine and Pharmacy University of Oradea, 1st December Square 10, 410073b Oradea, Romania, alinbodog@gmail.com

2 Departmant of Obstetrics and Gynecology, Pelican Hospital, 

Introduction. Postpartum hemorrhage (PPH) affects about 5% of births and is the leading cause of maternal death globally, responsible for around 25% of maternal fatalities[1-2]. Effective management is crucial[3]. Recently, new non-balloon intrauterine devices have been developed for PPH treatment, including Celox® gauze, the chitosan-covered tamponade (CT), and the Jada® System, a vacuum-based device[4].

Experimental. This study is based on a registry including all women who gave birth at a university hospital's perinatal department (over 5,000 deliveries annually) and received CT for postpartum hemorrhage between January 1, 2017, and June 6, 2022. Exclusion criteria were maternal age under 17, CT use solely for vaginal lacerations, or prior/simultaneous interventions like balloon tamponade, artery ligation, embolization, or compression sutures. Data were collected retrospectively from medical records, covering demographics, labor and delivery details, blood loss, infections, postpartum course, and newborn outcomes

Results and Discussion. Over 5.5 years, 270 women (0.92% of deliveries) at a university perinatal center received CT for postpartum hemorrhage (PPH), with 230 meeting inclusion criteria. CT was effective in 91.3% of cases (210 women), while 8.7% (20 women) required further intervention due to continued bleeding. Placenta previa was the main risk factor for treatment failure, increasing the risk 7.5-fold after adjusting for confounders. Cesarean delivery and placenta accreta spectrum (PAS) did not significantly affect CT outcomes. Other common risk factors, such as maternal age, multiple pregnancies, anemia, and stillbirth, also showed no notable impact on CT effectiveness in this cohort. [5–6].

Conclusions.Chitosan-covered tamponade (CT) effectively controlled postpartum hemorrhage in over 91% of cases. Placenta previa and delayed CT insertion were key factors in treatment failure. Early use of CT is recommended to reduce the need for invasive interventions, and in persistent cases, combining CT with compression sutures may improve outcomes.

Case Report. A 41-year-old primigravida at 38/39 weeks of gestation, with a pregnancy achieved via in vitro fertilization (IVF), was admitted for delivery. Delivery was performed via cesarean section. Intraoperatively, the uterus was noted to be atonic and unresponsive to standard pharmacological interventions, including uterotonic agents and hemostatic medications. Given the continued bleeding and failure of the uterus to contract adequately, a chitosan-covered intrauterine tamponade (CT) was inserted, followed by the placement of separate hemostatic sutures. This combined intervention successfully achieved hemostasis. The patient remained hemodynamically and respiratory stable postoperatively. Laboratory results one day postoperative day were as follows: Hemoglobin: 9.6 g/dL, Platelet count: 169,000/µL, Leukocyte count: 14.98 × 10³/µL, Fibrinogen: 404 mg/dL umder which the decision of eliminating the tamponade was taken. On the second postoperative day, the chitosan tamponade was removed via hysteroscopic intervention without complications. The patient continued to recover well under close monitoring.

References.

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