Department of Obstetrics, Charité University Hospital, Berlin, Germany.
Department of Obstetrics, Charité University Hospital, Berlin, Germany.
Am J Obstet Gynecol. 2024 Mar;230(3S):S1061-S1065. doi: 10.1016/j.ajog.2022.11.1297. Epub 2023 Aug 23.
Postpartum hemorrhage remains a major cause of maternal mortality and morbidity worldwide with higher rates found in resource-challenged countries. Conventional use of uterotonics such as oxytocin, prostaglandins, and medications to support coagulation, such as fibrinogen and tranexamic acid, are helpful but may not be sufficient to arrest life-threatening postpartum hemorrhage. Severe postpartum hemorrhage leads to an increased need for blood transfusions and the use of invasive techniques, such as intrauterine balloon tamponade, compression sutures, and arterial ligation, as advanced steps in the management cascade. In extreme cases where hemorrhage is resistant to these therapies, a hysterectomy may be necessary to avoid possible maternal death. Uterine packing with a chitosan-covered tamponade is an emerging tool in the armamentarium of the obstetrical team, especially when resources for advance surgical and other invasive options may be limited. Modified chitosan-impregnated gauze was originally described in the management of acute hemorrhage in the field of military medicine, combining the physiological antihemorrhaging effect of modified chitosan with a compression tamponade for the acute treatment of wound bleeding. The first described use in obstetrics was in 2012, showing that the chitosan-covered tamponade is an effective intervention to arrest ongoing therapy-resistant postpartum hemorrhage. Further studies showed a reduction in hysterectomies and blood transfusions. The method is, however, underreported and is not yet an established method used worldwide. To demonstrate the step-by-step application of the intrauterine chitosan-covered tamponade in the management of therapy-resistant postpartum hemorrhage, we have produced a teaching video to illustrate the important steps and techniques to optimize the effectiveness and safety of this novel intervention.
产后出血仍然是全球孕产妇死亡和发病的主要原因，资源匮乏国家的发病率更高。传统上使用缩宫素、前列腺素和支持凝血的药物（如纤维蛋白原和氨甲环酸）等子宫收缩剂有助于止血，但可能不足以控制危及生命的产后出血。严重的产后出血导致需要更多的输血和使用侵入性技术，如宫内球囊填塞、压迫缝合和动脉结扎，作为管理级联的高级步骤。在出血对这些治疗方法有抵抗力的极端情况下，可能需要进行子宫切除术以避免可能的产妇死亡。壳聚糖覆盖的宫腔填塞是产科团队的一种新兴工具，尤其是在资源有限无法进行先进的手术和其他侵入性选择时。改良壳聚糖浸渍纱布最初在军事医学领域的急性出血管理中描述，将改良壳聚糖的生理性止血作用与压迫填塞相结合，用于急性治疗伤口出血。2012 年首次在产科中描述了其用途，表明壳聚糖覆盖的宫腔填塞是一种有效的干预措施，可以控制正在进行的治疗抵抗性产后出血。进一步的研究表明，它减少了子宫切除术和输血。然而，该方法报道较少，尚未在全球范围内成为一种既定的方法。为了展示宫腔内壳聚糖覆盖的宫腔填塞在治疗抵抗性产后出血管理中的逐步应用，我们制作了一个教学视频，以说明该新型干预措施的重要步骤和技术，以优化其有效性和安全性。
