title: Uterine packing with chitosan-covered gauze for control of postpartum hemorrhage.
abstract: OBJECTIVE
  To describe the use of gauze covered with chitosan, a potent hemostatic agent derived from chitin, in the treatment of postpartum hemorrhage (PPH).
  
  
  METHODS
  Patients suffering from postpartum hemorrhage were treated by uterine packing with chitosan-covered gauze, either through the hysterotomy in case of cesarean delivery or transvaginally, for up to 24 hours.
  
  
  RESULTS
  Chitosan-covered gauze was used in 19 cases of postpartum hemorrhage due to uterine atony, placenta accreta/increta, or anticoagulation, including 5 severe cases where a hysterectomy seemed inevitable otherwise. In all but one case, the bleeding stopped and further interventions were avoided. Over comparable periods of time (18 months) and births (3822 vs 4077) before and after the introduction of the chitosan gauze in our clinic, the rate of peripartum hysterectomies was reduced by 75% (8 vs 2; odds ratio, 4.27; P = .044).
  
  
  CONCLUSIONS
  Chitosan-covered gauze is a viable option in the treatment of (severe) postpartum hemorrhage. It is easy to use and requires no special training. It can be used after both vaginal and cesarean deliveries, and there are no adverse side effects. Furthermore, it is very inexpensive compared with other treatment options, making it suitable for use also in low resource-countries, where the death toll due to postpartum hemorrhage is especially high.
authors.affiliation: Department of Obstetrics and Gynecology, Marienkrankenhaus Hamburg, Hamburg, Germany.
authors.forename: Bernd C
authors.initials: BC
authors.lastname: Schmid
authors.forename: Günther A
authors.initials: GA
authors.lastname: Rezniczek
authors.forename: Norbert
authors.initials: N
authors.lastname: Rolf
authors.forename: George
authors.initials: G
authors.lastname: Saade
authors.forename: Gerhard
authors.initials: G
authors.lastname: Gebauer
authors.forename: Holger
authors.initials: H
authors.lastname: Maul
mesh_terms: D000328:Adult; D001458:Bandages; D048271:Chitosan / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011247:Pregnancy
chemical_list: D048271:Chitosan
keywords: chitosan; postpartum hemorrhage; utero-vaginal packing