Chitosan-covered tamponade for the treatment of postpartum hemorrhage: a registry-based cohort study assessing outcomes and risk factors for treatment failure
Abstract Background Postpartum hemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality worldwide. Intrauterine hemostatic devices are recommended when PPH does not respond to medical treatment. The objective of this study was to assess the factors leading to unsuccessful in...
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BMC
2025-02-01
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| Series: | BMC Pregnancy and Childbirth |
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| Online Access: | https://doi.org/10.1186/s12884-025-07236-5 |
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| author | Clara Leichtle Annette Aigner Carolin Biele Paulina Hermann Teresa Dangli Charlotte Waldner Thorsten Braun Wolfgang Henrich Anna Maria Dückelmann |
| author_facet | Clara Leichtle Annette Aigner Carolin Biele Paulina Hermann Teresa Dangli Charlotte Waldner Thorsten Braun Wolfgang Henrich Anna Maria Dückelmann |
| author_sort | Clara Leichtle |
| collection | DOAJ |
| description | Abstract Background Postpartum hemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality worldwide. Intrauterine hemostatic devices are recommended when PPH does not respond to medical treatment. The objective of this study was to assess the factors leading to unsuccessful intrauterine therapy with a chitosan-covered tamponade (CT) for the treatment of PPH and to evaluate clinical outcomes based on real-world data. Methods This registry-based cohort study included all women treated with CT for PPH between January 2017 and June 2022 at a university clinic’s perinatal department. The endpoint was defined as the failure of CT, indicated by the requirement of further invasive procedures for ongoing hemorrhage after CT application. Medical records were reviewed and binary logistic regressions used to evaluate delivery mode, placenta previa, and placenta accreta spectrum as potential risk factors for CT treatment failure. Results The cohort consisted of 230 women, with successful CT treatment in 91.3%. The success rate for mild PPH was 100.0%, for moderate 95.5%, and for severe 84.2%. Five hysterectomies were performed in total. Placenta previa in cesarean sections was identified as the primary risk factor for CT treatment failure, increasing the odds about 7.5-fold (Odds Ratio: 7.48; 95% CI: 1.87–33.15) compared to cesarean sections without placenta previa. Furthermore, delays in CT insertion may also contribute to treatment failure. Conclusion CT serves as an intrauterine treatment for medically intractable PPH. Placenta previa significantly increases the risk of CT treatment failure in cesarean sections. Obstetricians should be particularly vigilant in managing patients with placenta previa and consider early use of CT or a combination of procedures. Trial registration This study was approved by the local Ethics Committee on 11/10/2021 (EA4/231/21). |
| format | Article |
| id | doaj-art-5d0db5cb1e1e4eaca2a8435d03407851 |
| institution | Kabale University |
| issn | 1471-2393 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj-art-5d0db5cb1e1e4eaca2a8435d034078512025-02-09T12:59:07ZengBMCBMC Pregnancy and Childbirth1471-23932025-02-0125111210.1186/s12884-025-07236-5Chitosan-covered tamponade for the treatment of postpartum hemorrhage: a registry-based cohort study assessing outcomes and risk factors for treatment failureClara Leichtle0Annette Aigner1Carolin Biele2Paulina Hermann3Teresa Dangli4Charlotte Waldner5Thorsten Braun6Wolfgang Henrich7Anna Maria Dückelmann8Department of Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu BerlinInstitute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu BerlinDepartment of Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu BerlinDepartment of Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu BerlinDepartment of Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu BerlinDepartment of Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu BerlinDepartment of Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu BerlinDepartment of Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu BerlinDepartment of Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu BerlinAbstract Background Postpartum hemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality worldwide. Intrauterine hemostatic devices are recommended when PPH does not respond to medical treatment. The objective of this study was to assess the factors leading to unsuccessful intrauterine therapy with a chitosan-covered tamponade (CT) for the treatment of PPH and to evaluate clinical outcomes based on real-world data. Methods This registry-based cohort study included all women treated with CT for PPH between January 2017 and June 2022 at a university clinic’s perinatal department. The endpoint was defined as the failure of CT, indicated by the requirement of further invasive procedures for ongoing hemorrhage after CT application. Medical records were reviewed and binary logistic regressions used to evaluate delivery mode, placenta previa, and placenta accreta spectrum as potential risk factors for CT treatment failure. Results The cohort consisted of 230 women, with successful CT treatment in 91.3%. The success rate for mild PPH was 100.0%, for moderate 95.5%, and for severe 84.2%. Five hysterectomies were performed in total. Placenta previa in cesarean sections was identified as the primary risk factor for CT treatment failure, increasing the odds about 7.5-fold (Odds Ratio: 7.48; 95% CI: 1.87–33.15) compared to cesarean sections without placenta previa. Furthermore, delays in CT insertion may also contribute to treatment failure. Conclusion CT serves as an intrauterine treatment for medically intractable PPH. Placenta previa significantly increases the risk of CT treatment failure in cesarean sections. Obstetricians should be particularly vigilant in managing patients with placenta previa and consider early use of CT or a combination of procedures. Trial registration This study was approved by the local Ethics Committee on 11/10/2021 (EA4/231/21).https://doi.org/10.1186/s12884-025-07236-5Postpartum hemorrhage (PPH)Chitosan-covered gauzeTreatment failureUterine packingPlacenta previa |
| spellingShingle | Clara Leichtle Annette Aigner Carolin Biele Paulina Hermann Teresa Dangli Charlotte Waldner Thorsten Braun Wolfgang Henrich Anna Maria Dückelmann Chitosan-covered tamponade for the treatment of postpartum hemorrhage: a registry-based cohort study assessing outcomes and risk factors for treatment failure BMC Pregnancy and Childbirth Postpartum hemorrhage (PPH) Chitosan-covered gauze Treatment failure Uterine packing Placenta previa |
| title | Chitosan-covered tamponade for the treatment of postpartum hemorrhage: a registry-based cohort study assessing outcomes and risk factors for treatment failure |
| title_full | Chitosan-covered tamponade for the treatment of postpartum hemorrhage: a registry-based cohort study assessing outcomes and risk factors for treatment failure |
| title_fullStr | Chitosan-covered tamponade for the treatment of postpartum hemorrhage: a registry-based cohort study assessing outcomes and risk factors for treatment failure |
| title_full_unstemmed | Chitosan-covered tamponade for the treatment of postpartum hemorrhage: a registry-based cohort study assessing outcomes and risk factors for treatment failure |
| title_short | Chitosan-covered tamponade for the treatment of postpartum hemorrhage: a registry-based cohort study assessing outcomes and risk factors for treatment failure |
| title_sort | chitosan covered tamponade for the treatment of postpartum hemorrhage a registry based cohort study assessing outcomes and risk factors for treatment failure |
| topic | Postpartum hemorrhage (PPH) Chitosan-covered gauze Treatment failure Uterine packing Placenta previa |
| url | https://doi.org/10.1186/s12884-025-07236-5 |
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