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.
Highlights
The incidence of postpartum hysterectomy varies from 0.2 to 1.74/1000 deliveries
We studied the healing of cesarean section scars, resorption of TachoSil, recovery of the endometrium at the site of TachoSil and formation of adhesion in the uterine cavity
Fifteen patients treated with TachoSil for excessive postpartum haemorrhage due to placenta previa in the period from January 1, 2007, to January 31, 2009, at the Department of Gynecology and Obstetrics, University Hospital of Aarhus, Skejby Sygehus, were invited for follow-up
Summary
The incidence of postpartum hysterectomy varies from 0.2 to 1.74/1000 deliveries. The most common indication for postpartum hysterectomy is abnormally adherent placenta (59%), 41% of which are due to placenta previa [1]. Delivery of patients with placenta previa is associated with the risk of excessive bleeding. 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. Eleven of 15 patients treated with TachoSil for excessive postpartum haemorrhage due to placenta previa were enrolled. 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
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