Application of chitosan-covered gauze in combination with intrauterine balloon tamponade for postpartum hemorrhage treatment - Case report of a novel "uterine sandwich" approach

Abstract

Introduction: Postpartum or peripartum hemorrhage (PPH) is a major cause of maternal death worldwide. Fertility preserving second stage interventions following uterotonic medications may include compression sutures, uterine balloon tamponade and ligation or embolization of arteries.

Presentation of case: We present a case of PPH where a novel "uterine sandwich" approach (combination of chitosan-covered gauze with intrauterine balloon tamponade) was effectively used to stop further blood loss and prevented more invasive second stage interventions. Furthermore, we present the ultrasonographic image of chitosan-covered gauze in the uterine cavity.

Discussion: Chitosan-covered gauze and intrauterine balloon tamponade are complementary in their mechanism of work, the balloon reducing blood flow into the uterus and the chitosan-covered gauze enhancing the coagulation.

Conclusion: This novel "uterine sandwich" approach can be a useful method for fertility preserving management of PPH.

Keywords: Chitosan-covered gauze; Intrauterine balloon tamponade; Obstetric complications; Postpartum hemorrhage.

Fig. 1

a, b: Transabdominal ultrasonographic view of a chitosan-covered gauze tamponade in utero (a) and uterus after removal of chitosan-covered gauze tamponade (b). (a): The uterus 48 h after delivery is partially filled with clotted blood in the fundal part of the uterine cavity (*). The chitosan-covered gauze tamponade presents as a hyperechogenic structure with dorsal acoustic shadow in the lower uterine segment. (b): After removal of chitosan-covered gauze tamponade small amount of clotted blood can be seen in the uterine cavity.