Different Uses of Chitosan for Treating Serious Obstetric Hemorrhages

Postpartum hemorrhage is a major cause of maternal death worldwide. Many therapeutic strategies have been developed to reduce maternal morbidity and mortality like oxytocin, prostaglandin, and uterine balloons. A new member of the therapeutic arsenal has recently emerged, the chitosan (Celox®), used since several years by military doctors to stop bleeding of combat wounds. In 2012, a first study was reported with the successful use of chitosan-coated gauze to treat severe postpartum hemorrhage. We report here three cases of the use of chitosan to treat life-threatening obstetric bleeding. In the first case, a pelvic packing with chitosan gauze after hemostatic hysterectomy with persistent bleeding. In the second case, the use of chitosan powder in a case of severe bleeding from multiple vaginal tears. In the third case, the use of chitosan gauze in uterine packing for postpartum hemorrhage by atonia. Postpartum hemorrhage of uterine origin resistant to treatment with prostaglandins can be treated with chitosancoated gauze. This treatment requires no training and its costs are one fifth those of a Bakri® intrauterine balloon. Using these two forms of chitosan, powder and gauze, we have developed a new therapeutic method at our disposal for dealing with the most serious cases of bleeding.