Clinic for Obstetrics, Charité, University Hospital, Berlin, Germany.
Clinic for Obstetrics, Charité, University Hospital, Berlin, Germany.
Eur J Obstet Gynecol Reprod Biol. 2019 Sep;240:151-155. doi: 10.1016/j.ejogrb.2019.06.003. Epub 2019 Jun 18.
Postpartum hemorrhage (PPH) is a major cause of maternal death worldwide. Management of PPH includes the administration of uterotonics, and intrauterine packing techniques.
In this study the effectiveness and safety of chitosan covered gauze versus a balloon tamponade for managing severe PPH should be assessed.
This retrospective cohort study was conducted at the Department of Obstetrics, Charité, university hospital Berlin, between October 2016 and June 2018. Women with PPH were treated according to management guidelines. When bleeding persisted, we applied additional uterine packing with either chitosan covered gauze or a balloon tamponade. The primary outcome was uterine bleeding termination without additional surgical interventions. Secondary outcomes included the amount of blood loss, the amount of blood transfusions and maternal complications.
Among the 78 patients included in this study, 47 (60.3%) received chitosan covered gauze tamponade and 31 (39.7%) received a balloon tamponade. The major reason for PPH was atonic bleeding, no statistically significant group differences were observed. With respect to the outcomes monitored, the groups were not significantly different in postpartum vital signs, hemoglobin levels, blood loss, admission to intensive care unit, or inflammation parameters. However, three patients in balloon tamponade group required a hysterectomy. No hysterectomy was required in gauze group.
Chitosan covered gauze is an excellent option for treating PPH, it appeared to be at least equivalent to the balloon tamponade, in our experience particularly suitable for atony or placenta bed bleeding after spontaneous delivery or during cesarean sections, in cases of lower uterine segment atony, placenta previa bed bleeding, and/or coagulopathy.
产后出血（PPH）是全球范围内导致产妇死亡的主要原因。PPH 的治疗包括使用宫缩剂和宫腔填塞技术。
本研究旨在评估壳聚糖覆盖纱布与球囊压迫在治疗严重产后出血中的有效性和安全性。
本回顾性队列研究于 2016 年 10 月至 2018 年 6 月在柏林夏洛蒂大学附属医院妇产科进行。根据管理指南对产后出血的妇女进行治疗。当出血持续时，我们采用壳聚糖覆盖纱布或球囊压迫进行额外的子宫填塞。主要结局是无额外手术干预的子宫出血停止。次要结局包括出血量、输血量和产妇并发症。
在这项研究中，78 名患者中，47 名（60.3%）接受了壳聚糖覆盖纱布填塞，31 名（39.7%）接受了球囊填塞。产后出血的主要原因是宫缩乏力，两组间无统计学差异。在监测的结局方面，两组在产后生命体征、血红蛋白水平、出血量、入住重症监护病房或炎症参数方面无显著差异。然而，球囊填塞组中有 3 名患者需要行子宫切除术。纱布填塞组无一例患者需要行子宫切除术。
壳聚糖覆盖纱布是治疗产后出血的一种极好选择，根据我们的经验，它似乎至少与球囊压迫等效，特别适用于自发性分娩或剖宫产时子宫下段宫缩乏力、胎盘附着部位出血和/或凝血功能障碍的情况。
