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Güngördük K, Ünver HC, Uyar BŞ, Ergü BN, Gülseren V, Özdemir İA. Efficacy of chitosan powder in reducing vaginal bleeding following a loop electrosurgical excision procedure: A randomized control trial. Int J Gynaecol Obstet 2025; 169:240-246. [PMID: 39614700 DOI: 10.1002/ijgo.16055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2024] [Revised: 11/09/2024] [Accepted: 11/12/2024] [Indexed: 12/01/2024]
Abstract
OBJECTIVE To evaluate the efficacy of topical chitosan powder in reducing postoperative vaginal bleeding following a loop electrosurgical excision procedure (LEEP). METHODS In this randomized controlled trial, patients who underwent LEEP were randomly assigned (1:1) to the chitosan group, in which the wound area was sprayed with chitosan powder using a spray pump, or the control group. The primary outcome was the median quantity of vaginal blood lost in the early postoperative period (defined as within 6 h of the procedure). RESULTS The 124 women enrolled in the study were randomly divided into control (n = 61) and chitosan (n = 63) groups. The median amount of vaginal blood loss during the early postoperative period was significantly lower in the chitosan group than in the control group (198.85 [64.4-388.57] mL vs. 250.60 [67.7-552.87] mL; P < 0.001). The rate of late postoperative bleeding requiring hemostatic intervention was also lower in the chitosan group than in the control group (3.2% vs. 16.4%; P = 0.013). Superior cervical wound healing in the chitosan group compared to the control group was also observed. CONCLUSION The application of chitosan powder to the cervical wound bed can improve surgical outcomes by decreasing post-LEEP vaginal bleeding and facilitating the healing of cervical wounds.
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Affiliation(s)
- Kemal Güngördük
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Hikmet Can Ünver
- Department of Obstetrics and Gynecology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Berican Şahin Uyar
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Berke Nur Ergü
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Varol Gülseren
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - İsa Aykut Özdemir
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Medipol University, İstanbul, Turkey
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Hale-Lopez KL, Saenz MM, Verma N, Chakravarthy S, Ebert-Allen R, Bond WF, Wooldridge AR. A SEIPS-Based Analysis to Understand Safety Culture During Postpartum Hemorrhage. Healthcare (Basel) 2025; 13:499. [PMID: 40077061 PMCID: PMC11899057 DOI: 10.3390/healthcare13050499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2024] [Revised: 02/14/2025] [Accepted: 02/18/2025] [Indexed: 03/14/2025] Open
Abstract
Background/Objectives: Maternal mortality occurs at alarming rates in the United States. In 2018, there were 17 maternal deaths for every 100,000 births-double that of other high-income countries, including France and Canada. Postpartum hemorrhage (i.e., excessive blood loss during delivery or within the 24 h following) is a leading cause of maternal mortality and is a treatable condition if identified and managed in a timely manner. One aspect of work that impacts patient care during postpartum hemorrhage is the safety culture. The safety culture is the beliefs, values, and norms shared by members of the organization that influence their actions and behaviors. In this study, we use the Systems Engineering Initiative for Patient Safety (SEIPS) model to understand and describe how the sociotechnical system shapes safety culture during postpartum hemorrhage. Methods: We conducted interviews and focus groups with 29 clinicians to describe the work system and the barriers and facilitators during postpartum hemorrhage. Then, we inductively categorized the barriers and facilitators into emergent properties of sociotechnical systems related to safety culture. Results: We identified 45 barriers and 158 facilitators into five emergent properties related to the safety culture (i.e., staffing, communication, organizational management and leadership, organizational processes, and teamwork). The participants identified more positive aspects than negative, suggesting that the safety culture positively influences their actions and behaviors. Conclusions: Our results indicate that safety culture could be improved by redesigning the work system to mitigate barriers related to staffing, communication, organizational management, and teamwork that hinder the safety culture.
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Affiliation(s)
- Kaitlyn L. Hale-Lopez
- Department of Industrial and Enterprise Systems Engineering, Grainger College of Engineering, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA
| | - Madelyn M. Saenz
- Department of Industrial and Enterprise Systems Engineering, Grainger College of Engineering, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA
| | - Neelam Verma
- Department of Obstetrics and Gynecology, University of Illinois College of Medicine Peoria, Peoria, IL 61805, USA
| | - Shruti Chakravarthy
- Department of Obstetrics and Gynecology, University of Illinois College of Medicine Peoria, Peoria, IL 61805, USA
| | - Rebecca Ebert-Allen
- Jump Simulation, a Collaboration of OSF Healthcare and the University of Illinois College of Medicine, Peoria, IL 61805, USA
| | - William F. Bond
- Jump Simulation, a Collaboration of OSF Healthcare and the University of Illinois College of Medicine, Peoria, IL 61805, USA
| | - Abigail R. Wooldridge
- Department of Industrial and Enterprise Systems Engineering, Grainger College of Engineering, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA
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Leichtle C, Aigner A, Biele C, Hermann P, Dangli T, Waldner C, Braun T, Henrich W, Dückelmann AM. Chitosan-covered tamponade for the treatment of postpartum hemorrhage: a registry-based cohort study assessing outcomes and risk factors for treatment failure. BMC Pregnancy Childbirth 2025; 25:120. [PMID: 39910452 PMCID: PMC11796112 DOI: 10.1186/s12884-025-07236-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2024] [Accepted: 01/24/2025] [Indexed: 02/07/2025] Open
Abstract
BACKGROUND Postpartum hemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality worldwide. Intrauterine hemostatic devices are recommended when PPH does not respond to medical treatment. The objective of this study was to assess the factors leading to unsuccessful intrauterine therapy with a chitosan-covered tamponade (CT) for the treatment of PPH and to evaluate clinical outcomes based on real-world data. METHODS This registry-based cohort study included all women treated with CT for PPH between January 2017 and June 2022 at a university clinic's perinatal department. The endpoint was defined as the failure of CT, indicated by the requirement of further invasive procedures for ongoing hemorrhage after CT application. Medical records were reviewed and binary logistic regressions used to evaluate delivery mode, placenta previa, and placenta accreta spectrum as potential risk factors for CT treatment failure. RESULTS The cohort consisted of 230 women, with successful CT treatment in 91.3%. The success rate for mild PPH was 100.0%, for moderate 95.5%, and for severe 84.2%. Five hysterectomies were performed in total. Placenta previa in cesarean sections was identified as the primary risk factor for CT treatment failure, increasing the odds about 7.5-fold (Odds Ratio: 7.48; 95% CI: 1.87-33.15) compared to cesarean sections without placenta previa. Furthermore, delays in CT insertion may also contribute to treatment failure. CONCLUSION CT serves as an intrauterine treatment for medically intractable PPH. Placenta previa significantly increases the risk of CT treatment failure in cesarean sections. Obstetricians should be particularly vigilant in managing patients with placenta previa and consider early use of CT or a combination of procedures. TRIAL REGISTRATION This study was approved by the local Ethics Committee on 11/10/2021 (EA4/231/21).
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Affiliation(s)
- Clara Leichtle
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Annette Aigner
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin, Germany
| | - Carolin Biele
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Paulina Hermann
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Teresa Dangli
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Charlotte Waldner
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Thorsten Braun
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Wolfgang Henrich
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Anna Maria Dückelmann
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.
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Henrich W, Paping A. Postpartum Ultrasound: An Indispensable Tool in the Labor Ward. Clin Obstet Gynecol 2024; 67:739-752. [PMID: 39431494 DOI: 10.1097/grf.0000000000000889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2024]
Abstract
Postpartum hemorrhage can occur because of different conditions. Apart from placental remnants and uterine atony, less common causes include uterine rupture, placental polyps, arteriovenous malformations, and pseudoaneurysms. Ultrasound plays a key role in the precise definition of the underlying pathology, which is necessary to initiate the appropriate therapy. It also helps to depict intraabdominal hematomas and uterine scar dehiscence, 2 conditions that do not necessarily lead to postpartum hemorrhage but are associated with increased maternal morbidity. This article presents 52 ultrasound images together with clinical and histopathologic images to give an overview of both frequent and rare pathologies in the postpartum period.
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Affiliation(s)
- Wolfgang Henrich
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Obstetrics, Berlin, Germany
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Velasco Sordo R, López Maldonado H, Ramirez Flores DA, Ibarrola Buen Abad E, Vilchis Nava P. Chitosan Gauze in the Management of Acute Postpartum Hemorrhage in a Mexican Third-Level Institution: A Case Report. Cureus 2024; 16:e71079. [PMID: 39512975 PMCID: PMC11542541 DOI: 10.7759/cureus.71079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2024] [Indexed: 11/15/2024] Open
Abstract
Obstetric hemorrhage is the main cause of maternal death worldwide; over the years, its management has been based on uterotonic drugs as well as definitive and non-definitive surgical techniques. We report the case of a patient with multiple risk factors for obstetric hemorrhage who was given the classic management for postpartum hemorrhage before the addition of chitosan gauze, which resulted in adequate remission of the condition. The patient had an adequate in-hospital evolution; the chitosan gauze was removed after 24 hours, and she was discharged after 48 hours without active bleeding. When identifying women at high risk of obstetric hemorrhage, having chitosan gauze in the operating room could be a point of good care.
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Affiliation(s)
- Roberto Velasco Sordo
- Obstetrics and Gynecology, Centro Médico American British Cowdray (ABC), Mexico City, MEX
| | | | | | | | - Pablo Vilchis Nava
- Obstetrics and Gynecology, Centro Médico American British Cowdray (ABC), Mexico City, MEX
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Brauer SK, Musy AA, Schneider S, Trottmann FN, Kaderli N, Vetter C, Surbek D, Schindewolf M, Gerber AL, Stotz M, Hautz W, Zdanowicz JA. Using Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as a Rescue Strategy in Severe Postpartum Hemorrhage: A Case Report. Diagnostics (Basel) 2024; 14:1980. [PMID: 39272763 PMCID: PMC11394129 DOI: 10.3390/diagnostics14171980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 09/03/2024] [Accepted: 09/05/2024] [Indexed: 09/15/2024] Open
Abstract
Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality. Routine treatment of PPH includes uterotonics, tranexamic acid, curettage, uterine (balloon) tamponade, compression sutures, uterine artery ligation, and, if available, transcatheter arterial embolization (TAE). In cases of severe PPH refractory to standard medical and surgical management, hysterectomy is usually the ultima ratio, and is equally associated with a higher rate of complications. In addition, this sudden loss of fertility, especially in young women, can be devastating. Here, we report a case of a 29-year-old woman who suffered from severe PPH with a blood loss > 1500 mL and hemodynamic instability after delivery of her first baby at a smaller hospital. She was consequently successfully treated with resuscitative endovascular balloon occlusion of the aorta (REBOA) by first placing a balloon catheter into the infra-renal aorta and subsequent TAE after failure of all other available treatment options prior to hysterectomy. TAE has been suggested in PPH treatment to avoid hysterectomies and thus to preserve patients' reproductive function. If hemodynamic stabilization cannot be achieved with mass transfusion, REBOA seems to be an effective rescue strategy with which to achieve hemodynamic stabilization and gain additional time for embolization. Although REBOA is already recommended in several PPH guidelines, this approach seems relatively unknown in German-speaking countries.
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Affiliation(s)
- Sophie-Kristin Brauer
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Alexandre Athanasios Musy
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Sophie Schneider
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Fabienne Nicole Trottmann
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Nina Kaderli
- Department of Obstetrics, Spital Emmental, 3400 Burgdorf, Switzerland
| | - Christian Vetter
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Daniel Surbek
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Marc Schindewolf
- Department of Angiology, Inselspital, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
| | - Anna Lea Gerber
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Manuela Stotz
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Wolf Hautz
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Jarmila A Zdanowicz
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
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Romero R, Sabo Romero V, Kalache KD, Stone J. Parturition at term: induction, second and third stages of labor, and optimal management of life-threatening complications-hemorrhage, infection, and uterine rupture. Am J Obstet Gynecol 2024; 230:S653-S661. [PMID: 38462251 DOI: 10.1016/j.ajog.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Childbirth is a defining moment in anyone's life, and it occurs 140 million times per year. Largely a physiologic process, parturition does come with risks; one mother dies every two minutes. These deaths occur mostly among healthy women, and many are considered preventable. For each death, 20 to 30 mothers experience complications that compromise their short- and long-term health. The risk of birth extends to the newborn, and, in 2020, 2.4 million neonates died, 25% in the first day of life. Hence, intrapartum care is an important priority for society. The American Journal of Obstetrics & Gynecology has devoted two special Supplements in 2023 and 2024 to the clinical aspects of labor at term. This article describes the content of the Supplements and highlights new developments in the induction of labor (a comparison of methods, definition of failed induction, new pharmacologic agents), management of the second stage, the value of intrapartum sonography, new concepts on soft tissue dystocia, optimal care during the third stage, and common complications that account for maternal death, such as infection, hemorrhage, and uterine rupture. All articles are available to subscribers and non-subscribers and have supporting video content to enhance dissemination and improve intrapartum care. Our hope is that no mother suffers because of lack of information.
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Affiliation(s)
- Roberto Romero
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI.
| | | | - Karim D Kalache
- Department of Clinical Obstetrics and Gynecology, Weill Cornell Medical College-Qatar Division, Doha, Qatar; Division of Maternal-Fetal Medicine, Women's Services, Sidra Medicine, Doha, Qatar
| | - Joanne Stone
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY
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