title: Torrential epistaxis in the third trimester: a management conundrum.
abstract: Although epistaxis is common during pregnancy, large volume epistaxis is rare. Many standard epistaxis management options are limited in pregnancy due to absolute or relative contraindications. Ear, nose and throat surgeons need to be aware of what options can be used safely and effectively. We present a case of a 32-year-old woman, 32 weeks pregnant, who was admitted with heavy epistaxis refractive to conservative management. Several potential interventions including bismuth iodoform paraffin paste (BIPP) and Floseal were contraindicated or involved additional risk in pregnancy necessitating unorthodox management. This challenging case highlights suitable alternatives for managing large volume epistaxis during pregnancy, as well as discussing the differential diagnosis and relevant investigations.
authors.affiliation: Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Rosa Elizabeth Mary
authors.initials: RE
authors.lastname: Crunkhorn
authors.affiliation: Department of ENT, Shrewsbury and Telford Hospitals, Telford, UK.
authors.forename: Alistair
authors.initials: A
authors.lastname: Mitchell-Innes
authors.affiliation: Department of Ear, Nose and Throat Surgery, Burton Hospital NHS Foundation Trust, Burton upon Trent, UK.
authors.forename: Jameel
authors.initials: J
authors.lastname: Muzaffar
mesh_terms: D000328:Adult; D001729:Bismuth; D000075202:Contraindications; D019468:Disease Management; D004338:Drug Combinations; D004844:Epistaxis / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005781:Gelatin Sponge, Absorbable; D006801:Humans; D006847:Hydrocarbons, Iodinated; D009666:Nose / Q000473:pathology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000628:therapy*; D011263:Pregnancy Trimester, Third
chemical_list: D004338:Drug Combinations; C411004:FloSeal Matrix; D006847:Hydrocarbons, Iodinated; C045757:bismuth iodoform paraffin paste; D001729:Bismuth