Uterine packing with chitosan-covered gauze compared to balloon tamponade for managing postpartum hemorrhage.

BACKGROUND: Postpartum hemorrhage (PPH) is a major cause of maternal death worldwide. Management of PPH includes the administration of uterotonics, and intrauterine packing techniques. OBJECTIVE: In this study the effectiveness and safety of chitosan covered gauze versus a balloon tamponade for managing severe PPH should be assessed. STUDY DESIGN: 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. RESULTS: 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. CONCLUSION: 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.

Functional and anatomic results of amnion vaginoplasty in young women with Mayer-Rokitansky-Küster-Hauser syndrome.

OBJECTIVE: To evaluate the surgical outcome and the long-term anatomic and functional results in young women with Mayer-Rokitansky-Küster-Hauser Syndrome (MRKH) undergoing neovaginal creation with amniotic membranes. DESIGN: Evaluation of surgical and functional outcome according to clinical records and validated questionnaires about sexuality (Female Sexual Function Index [FSFI]) over a 1.5-year follow-up period. SETTING: University hospital and referral center for pediatric and adolescent gynecology. PATIENT(S): Seven patients with congenital vaginal aplasia with a mean age of 20.86 +/- 3.56 years (range 17-26 years). INTERVENTION(S): McIndoe procedure modified by the application of human freeze-dried amniotic membranes. MAIN OUTCOME MEASURE(S): Anatomic success was defined by a vaginal length >or=8 cm, and a width allowing the easy introduction of two fingers. FSFI scores were applied to define functional results. RESULT(S): Mean neovaginal length was 9.3 cm (range 4-12 cm). The mean FSFI score was 30.0 +/- 6.9. Major operative complications occurred in one patient. In six out of seven patients satisfactory anatomic and functional results were achieved. CONCLUSION(S): The surgical dissection of the vesicorectal space and the application of human amnion over a vaginal mold to create a neovagina results in satisfying anatomic and functional outcome with low perioperative morbidity in MRKH patients.