Uterine Healing after Therapeutic Intrauterine Administration of TachoSil (Hemostatic Fleece) in Cesarean Section with Postpartum Hemorrhage Caused by Placenta Previa

Abstract

Background. Application of hemostatic fleece (TachoSil) directly onto the bleeding surfaces of the lower uterine segment has been used to obtain hemostasis during cesarean section caused by placenta previa. Methods. Eleven of 15 patients treated with TachoSil for excessive postpartum haemorrhage due to placenta previa were enrolled. An evaluation of the cesarean section scar by transvaginal ultrasound, the uterine cavity and endometrium by hysteroscopy, and the endometrium by biopsy were made. The main outcome measures were intrauterine adhesions, recovery of endometrium at the site of TachoSil application, visible remnants of TachoSil, and scar healing. Results. Eight patients had small remnants of TachoSil in the uterine cavity together with signs of resorption. All had a normal endometrial mucosa, and none had adhesions in the uterine cavity. All cesarean section scars were healed without defects. Conclusion. TachoSil did not seem to impair healing of the endometrium or scar formation in the uterus after intrauterine application. Resorption of TachoSil seems to progress individually. Intrauterine treatment with TachoSil is a valuable supplement to the traditional treatment of post partum haemorrhage and may help retain reproductive capability. This is a small study, and it will require more studies to confirm the reproducibility.

Treatment strategies for post-infarction left ventricular free-wall rupture

“…Collagen sponges, or fleeces, have been utilized in other surgical specialties, ranging from gynaecology, urology and liver surgery. 37,38 The use of collagen sponges in cardiac surgery is not new; its safety has been assessed in different cardio-thoracic procedures. 39 However, the indication for using TachoComb® or TachoSil® patches in LVFWR repair has become more common only in recent years, based on preliminary favourable results.…”

Fahmy's four quadrant sutures: a new technique for control of blood loss during cesarean delivery for placenta previa

“…Application of local hemostatic agent, hemostatic fleece, hemostatic gel directly on the bleeding surfaces of the lower uterine segment has been used to achieve hemostasis during cesarean section produced by placenta previa, it provides rapid and active hemostasis in the lower segment, where surgical interference may be problematic, although quick and effective are not suitable in various cases especially placenta previa accreta and these agents are not permanently obtainable in developing countries. 20,21 Most of the compression sutures such as B-Lynch, Hayman and Cho square designed for atonic PPH and cannot prevent hemorrhage within the lower uterine segment all the time. However, several specific stitches were established to stop bleeding in this challenging anatomical area, such as Transverse annular compression sutures, antero posterior compressive suture of the lower uterine segment, multiple 8 sutures are informed to be effective in controlling severe PPH from the lower uterine segment with a varying degree of success.…”

Sutureless management of left ventricle wall rupture; a series of three cases

“…Collagen sponges have been used in different surgical specialties ranging from urology, gynecology and liver surgery [ 4 ]-[ 6 ]. The use of collagen sponges in cardiac surgery is not new, its safety has been assessed in different cardiothoracic procedures [ 7 ]-[ 9 ].…”