Monsel's Solution Research Articles

Cervical bleeding with cervical stabilization during IUD placement: allis clamp versus single-tooth tenaculum, a randomized control trial.

To evaluate whether the use of an atraumatic Allis clamp will result in less bleeding than the standard single-tooth tenaculum for cervical stabilization during intrauterine device (IUD) placement. A single-blinded randomized controlled trial was conducted during insertions of IUDs between March 2017 and March 2018. University of Kentucky Institutional Review Board (IRB 16-1110-P3K) approval was obtained. Physicians were randomized to use either an Allis clamp or a single-tooth tenaculum for cervical stabilization. A post-procedure questionnaire was used to collect outcome measures as well as demographic and obstetric-related factors. Of the ninety-five participants, there was no difference in age, self-identified race/ethnicity, or the evaluated obstetric factors between the groups. Bleeding was present after clamp removal in 3 (6.3%) insertions using an Allis clamp and 26 (55.3%) insertions using a single-tooth tenaculum (RR = 0.113, CI = [0.037, 0.3481], p < 0.0001). There was no difference in IUD insertion success rates between the two clamps. There was no difference in the number of interventions needed to obtain hemostasis including indirect pressure, silver nitrate, monsel's solution, or stitch for hemostasis. Pain scores did not differ based on clamp type or age of patient, but were significantly different based on parity (p < 0.001) and IUD type (p < 0.003). Decreased incidence of bleeding from cervical stabilization device, with unchanged insertion success using the Allis clamp can be an alternative to the single tooth tenaculum in the procedure of IUD insertion. The trial was retrospectively registered on 1/11/22 (trial registration number NCT05187078).

P.72 Accidental oral administration of Monsel's solution during caesarean delivery

P.72 Accidental oral administration of Monsel's solution during caesarean delivery

A Cervical Smear Scare due to Monsel’s Solution: A Case Report

Monsel’s solution has been in use since the end of the 19th century for its valuable property of creating hemostasis in minor disruptions of the epithelium. Its styptic effect was first described by Leon Monsel, a pharmacist in the French army, in a letter dated on October 13, 1852. Containing ferric subsulphate, it is used as a topical hemostatic agent in minor procedures such as biopsies in gynecology, proctology, dermatology, otorhinolaryngology and odontology. A 28-year-old nulliparous woman, with a known history of adenomyosis, had presented for sudden heavy intermenstrual vaginal bleeding. Examination revealed a bleeding Nabothian cyst. Monsel’s solution application helped stop the bleeding. She returned 3 days later with persistent heavy vaginal bleeding. Examination showed active oozing from the Nabothian cyst. A cervical smear and a human papillomavirus (HPV) swab were taken, and vaginal packing was inserted. The cervical smear result was reported as atypical cells, suspicious for malignancy. Colposcopy performed showed a grade 2 acetowhite lesion, suspicious for cervical intraepithelial neoplasia (CIN) III/microinvasive disease. However, punch biopsies of the cervix revealed only CIN I/koilocytosis. The patient was counselled and subsequently underwent a laser cone biopsy, which showed CIN I with clear margins. The discrepant results between the cervical smear and the cone biopsy prompted a review of the cervical smear and cervical histology; and a relook at the chronology of events. The cytological features observed in the initial cervical smear could be explained by the interference from the Monsel’s solution, which was applied just 3 days before the cervical smear. In cases where Monsel’s solution has been used for hemostasis, it is best to delay taking a cervical smear or a biopsy for at least 3 weeks as the histologic effect of Monsel’s solution may persist for up to that duration of time in tissues. J Med Cases. 2020;11(10):324-326 doi: https://doi.org/10.14740/jmc3556

Hemostatic activity of aqueous extract of Myrtus communis L. leaf in topical formulation: In vivo and in vitro evaluations.

Myrtus communis L. (MC) is a well-known medicinal plant in traditional Persian medicine, which contains a large amount of phenolic compounds (mainly hydrolyzable tannins). As mentioned in ancient literature, MC was widely used to control bleeding in every part of the body. Nevertheless, there is no pharmacological study on the anti-hemorrhagic activity of this plant till now. The current in vivo and in vitro study aimed at evaluating the hemostatic activity of M. communis aqueous leaf extract (MCE) in topical formulation. Two parameters of bleeding time and amount in tail bleeding model were measured in vivo in rats treated with MCE (1%, 2.5%, 5%, 7.5%, 10%, 15%, and 20% w/v), 5% M. communis aqueous leaf extract gel (G), tannic acid (TA) (1%, 2.5%, 5%, 7.5%, and 10%), normal saline (NS), and the Monsel's solution (MS), a commercial hemostatic agent. Also, the effect of 5% MCE and 5% TA on PT (prothrombin time) and aPTT (activated partial thromboplastin time) as well as protein precipitation and platelet aggregation were assessed in vitro. In the rat-tail bleeding model, bleeding time and amount significantly (P<0.001) reduced by the application of 5% MCE solution on the cut tail compared with the NS group. The bleeding time and amount in the MS group were not significantly different from those of the 5% MCE group. Platelet microaggregates were detected by fluorescent microscope. PT and aPTT values increased >120s and >180s by 5% MCE, respectively. Also, protein precipitation and significant reduction in serum proteins were observed in the 5% MCE group. The current study provided new insights into the hemostatic effect of MCE, which may be partially mediated by platelet aggregation activity. Hence, it could be evaluated as the resource of new plant origin hemostatic agent.

Topical Aluminum Chloride and Monsel's Solution Block Toluidine Blue Staining in Mohs Frozen Sections: Mechanism and Solution.

A diminished-staining artifact is observed in some Mohs frozen sections that are stained in toluidine blue (T-blue). Such an artifact, not yet described in the literature, may interfere with a Mohs surgeon's accurate reading. The authors hypothesize that topical hemostatic agents, aluminum chloride, and Monsel's solution are the causative factors. To evaluate the aforementioned topical hemostatic agents as a potential cause of the nonstaining artifact, to propose the mechanism associated with this phenomenon, and to develop a method to prevent or rectify the problem. Leftover Mohs frozen sections and specimens were treated with aluminum chloride or Monsel's solution and processed with routine Mohs histology. Nonstaining artifact is reproduced in aluminum chloride or Monsel's solution-treated ex vivo skin specimens. The authors found that ethylenediaminetetraacetic acid (EDTA), a chelating agent, can reverse the staining blockage. Such a finding suggests that aluminum or ferric cations bind to tissue and subsequently inhibit T-blue from interacting with the tissue. Direct binding of ferric cations to the tissue section is demonstrated with Prussian blue iron staining. By rinsing Mohs frozen sections in an EDTA solution before T-blue staining, the authors could prevent hemostatic agent-induced nonstaining. Applying an EDTA wash and restaining the slides can correct the same artifact.

Application of Monsel's solution after cervical biopsy: a randomized trial

Application of Monsel's solution after cervical biopsy: a randomized trial

Efficacy of Monsel Solution After Cervical Biopsy: A Randomized Trial.

To estimate the efficacy and side effects of Monsel solution for hemostasis after cervical punch biopsy. In a prospective, randomized trial, we compared application of Monsel solution versus a "wait and see" approach in women undergoing cervical punch biopsies in a 1:1 ratio. The primary end point was vaginal bleeding (VB) after 15 minutes measured by scoring a sanitary pad with a 5-level pictogram. Secondary end points were VB after 3, 6, and 24 hours (5-level pictogram), subjective estimation of overall VB during 24 hours, pain after 15 minutes and subjective estimation of overall pain after 24 hours, and overall satisfaction after 24 hours (11-level visual analogue scale). One hundred forty-five women were randomized between July 2015 and January 2016. Mean objective VB scores after 15 minutes in 75 women with Monsel solution were 1.2 ± 0.6 compared with 1.8 ± 1.0 in 70 women without Monsel solution (P < 0.001). The secondary end points VB after 3 and 6 hours, but not after 24 hours, were also in favor of Monsel solution (2.1 ± 1.1 vs 2.9 ± 1.2; P < 0.001; 1.6 ± 0.7 vs 2.2 ± 1.0; P < 0.001; 1.6 ± 0.9 vs 1.7 ± 0.9; P = 0.4, respectively). Subjective estimation of overall VB during 24 hours was lower for Monsel solution (23.2 ± 15.8 vs 35.9 ± 19.5; P < 0.001), but pain after 15 minutes, overall pain, and overall satisfaction were not significantly different between groups (19.2 ± 14.4 vs 17.9 ± 16.2; P = 0.3; 20.7 ± 15.8 vs 20.1 ± 18.0; P = 0.5; and 44.1 ± 21.5 vs 43.6 ± 23.2; P = 0.9, respectively). Application of Monsel solution significantly reduces bleeding for 6 hours after cervical biopsy but does not affect overall pain or overall satisfaction.

Interventions for preventing blood loss during the treatment of cervical intraepithelial neoplasia.

Cervical intraepithelial neoplasia (CIN) is the most common pre-malignant lesion. Surgical treatments for CIN are commonly associated with blood loss. To assess the effectiveness and safety of interventions for preventing blood loss during the treatment of CIN. We searched the Cochrane Gynaecological Cancer Group Trials Register, MEDLINE, EMBASE and CENTRAL up to November 2012. We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of included studies. Randomised controlled trials (RCTs) of vasopressin, tranexamic acid, haemostatic sutures, Amino-Cerv or Monsel's solution in women undergoing surgery for CIN. Two reviewers independently abstracted data and assessed risk of bias. Risk ratios comparing adverse events in women who received one of the interventions were pooled in a random-effects meta-analyses or included in single trial analyses. Twelve RCTs (N = 1602, of whom 1512 were assessed) were included.Vasopressin significantly reduced perioperative bleeding (mean difference (MD) = -100.80, 95% confidence interval (CI) -129.48 to -72.12) and was associated with a decreased risk of bleeding that required haemostatic sutures or further vasopressin, compared to placebo (risk ratio (RR) = 0.39, 95% CI 0.27 to 0.56).Tranexamic acid significantly reduced risk of secondary haemorrhage (RR = 0.23, 95% CI 0.11 to 0.50), but not primary haemorrhage (RR = 1.24, 95% CI 0.04 to 38.23) after knife and laser cone biopsy, compared with placebo. There was also a statistically significant reduction in postoperative blood loss compared with placebo (MD = -55.60, 95% CI -94.91 to -16.29).Packing with Monsel's solution resulted in less perioperative blood loss (MD = -22.00, 95% CI -23.09 to -20.91) and decreased the risk of dysmenorrhoea (RR = 0.37, 95% CI 0.16 to 0.84), unsatisfactory colposcopy (RR = 0.43, 95% CI 0.30 to 0.63) and cervical stenosis (RR = 0.35, 95% CI 0.25 to 0.49) compared to routine suturing, but was not statistically different to sutures for risk of primary and secondary haemorrhages.Amino-Cerv antibiotic gel failed to make a difference on secondary haemorrhage but was associated with significantly less vaginal discharge at 2 weeks compared with routine care (RR = 0.27, 95% CI 0.09 to 0.86).There was no significant difference in blood loss between women who received ball electrode diathermy and those who received Monsel's paste (MD = 4.82, 95% CI -3.45 to 13.09). Bleeding associated with surgery of the cervix appears to be reduced by vasopressin, used in combination with local anaesthetic. Tranexamic acid appears to be beneficial after knife and laser cone biopsy. There are insufficient data to assess the effects on primary haemorrhage. There is some evidence that haemostatic suturing has an adverse effect on blood loss, cervical stenosis and satisfactory colposcopy.

Use of ferric subsulfate (Monsel's) Solution for hemostasis at the conclusion of transvaginal oocyte retrieval is detrimental to pregnancy outcomes in fresh-transferred in vitro fertilization cycles

(grade A) were in their majority (144/213 or 67.6%) euploid. Of the 173 average quality blastocyts (grade B) 99 were euploid (57.2%) and 18/80 (22.5%) of poor quality blastocyst (grade C) were euploid. Importantly, among the best quality aneuploidy blastocysts, 42/69 (60.9%) were found to be affected by a single aneuploidy. CONCLUSION: Blastocyst morphology showed a significant link to aneuploidy (p<0.05), as approximately 67.6% of the best quality embryos were chromosomally normal, and the remaining abnormal. Meanwhile, only 22.5% of poor quality blastocysts were euploid. Most abnormal high quality blastocysts had a single anomaly. Supported by: Red Rock Fertility Center.

Interventions for preventing blood loss during the treatment of cervical intraepithelial neoplasia.

Cervical intraepithelial neoplasia (CIN) is the most common pre-malignant lesion. Surgical treatments for CIN are commonly associated with blood loss. To assess the effectiveness and safety of interventions for preventing blood loss during the treatment of CIN. We searched the Cochrane Gynaecological Cancer Group Trials Register, MEDLINE, EMBASE and CENTRAL up to April 2009. We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of included studies. Randomised controlled trials (RCTs) of vasopressin, tranexamic acid, haemostatic sutures, Amino-Cerv or Monsel's solution in women undergoing surgery for CIN. Two reviewers independently abstracted data and assessed risk of bias. Risk ratios comparing adverse events in women who received one of the interventions were pooled in a random-effects meta-analyses or included in single trial analyses. Twelve RCTs (N = 1602, of whom 1512 were assessed) were included.Vasopressin significantly reduced perioperative bleeding (mean difference (MD) = -100.80, 95% confidence interval (CI) -129.48 to -72.12) and was associated with a decreased risk of bleeding that required haemostatic sutures or further vasopressin, compared to placebo (risk ratio (RR) = 0.39, 95% CI 0.27 to 0.56).Tranexamic acid significantly reduced risk of secondary haemorrhage (RR = 0.23, 95% CI 0.11 to 0.50), but not primary haemorrhage (RR = 1.24, 95% CI 0.04 to 38.23) after knife and laser cone biopsy, compared with placebo. There was also a statistically significant reduction in postoperative blood loss compared with placebo (MD = -55.60, 95% CI -94.91 to -16.29).Packing with Monsel's solution resulted in less perioperative blood loss (MD = -22.00, 95% CI -23.09 to -20.91) and decreased the risk of dysmenorrhoea (RR = 0.37, 95% CI 0.16 to 0.84), unsatisfactory colposcopy (RR = 0.43, 95% CI 0.30 to 0.63) and cervical stenosis (RR = 0.35, 95% CI 0.25 to 0.49) compared to routine suturing, but was not statistically different to sutures for risk of primary and secondary haemorrhages.Amino-Cerv antibiotic gel failed to make a difference on secondary haemorrhage but was associated with significantly less vaginal discharge at 2 weeks compared with routine care (RR = 0.27, 95% CI 0.09 to 0.86).There was no significant difference in blood loss between women who received ball electrode diathermy and those who received Monsel's paste (MD = 4.82, 95% CI -3.45 to 13.09). Bleeding associated with surgery of the cervix appears to be reduced by vasopressin, used in combination with local anaesthetic. Tranexamic acid appears to be beneficial after knife and laser cone biopsy. There are insufficient data to assess the effects on primary haemorrhage. There is some evidence that haemostatic suturing has an adverse effect on blood loss, cervical stenosis and satisfactory colposcopy.

P08.04: Ultrasound follow-up of patients treated with monsels solution for placenta accreta

P08.04: Ultrasound follow-up of patients treated with monsels solution for placenta accreta

Routine prophylactic application of Monsel's solution after loop electrosurgical excision procedure of the cervix: Is it necessary?

To determine the benefit of an immediate application of Monsel's solution after loop electrosurgical excision procedure (LEEP) of the cervix for preventing postoperative bleeding. This randomized controlled trial was conducted at Chiang Mai University Hospital, Chang Mai, Thailand. Women who were scheduled for LEEP were approached for participation in the study. The primary endpoint was the duration of uncomplicated vaginal bleeding. Secondary endpoints were the incidence of persistent vaginal bleeding, and postoperative complications including severe early bleeding, severe delayed bleeding and infection. Between October 2004 and May 2006, 285 women with an abnormal Pap-smear, who had undergone LEEP, were randomly allocated to the Monsel's group (n = 140) or control group (n = 145). The baseline outcomes were similar between the two groups. In the Monsel's group, the duration of uncomplicated vaginal bleeding was significantly shorter (P < 0.001) and the occurrence of persistent vaginal bleeding was significantly lower (P = 0.014) than in the control group. The occurrence of severe complications that required treatment, including bleeding and infection, was not significantly different between the two groups (P = 0.379). An application of Monsel's solution after LEEP appears to reduce the duration of postoperative vaginal bleeding, but does not significantly prevent severe complications. Such practice may not be necessary if adequate hemostasis is achieved using electrical cauterization.

The use of intrauterine Monsel’s solution in severe hemorrhage after evacuation of retained products of conception: a case report

This is the first reported case of the use of Monsel's solution to arrest excessive uterine bleeding after the evacuation of retained products of conception after a miscarriage. Monsel's solution impregnated into a uterine pack was used to secure hemostasis. Fertility was preserved because 7 months later the woman became pregnant and had an uncomplicated pregnancy and delivery at term. Monsel's solution can be used therefore if other conventional methods were applied unsuccessfully to stop the uterine hemorrhage.

Be Prepared

Be Prepared

The use of Monsel's solution and vaginal pack for haemostasis in cold knife cone biopsy

"The use of Monsel's solution and vaginal pack for haemostasis in cold knife cone biopsy." Journal of Obstetrics and Gynaecology, 27(2), p. 189

More on Monsel's solution...

A 46-year-old previously healthy woman was referred to the general surgery service in extremis after cervical cone biopsy for carcinoma in situ. The cone biopsy proceeded under general anesthesia by infiltrating the cervix with 1% lidocaine and epinephrine. An attempt was made to create a large circumferential surgical margin with the use of a 11# knife in the cervix. After removal of the specimen, the patient was noted to have bleeding along the surgical margin. Visualization of the surgical field was suboptimum. The surgical area and vagina were packed and pressure applied. Upon removal of the packing, bleeding was still noticed, and an attempt to pack the area with pads soaked in Monsel's solution was performed. Once the bleeding abated, the patient was taken to the recovery room. Within 30 minutes, signs of hypovolemic shock were recognized in the recovery room, together with increasing abdominal distension and peritoneal signs. Immediate resuscitation was performed and the patient was returned to the operating room within the hour for urgent celiotomy for intra-abdominal hemorrhage. At this time her hemoglobin concentration was 4 g/dL.

Hemostasis following cervical punch biopsy using Monsel's solution

Hemostasis is of utmost concern after cervical punch biopsy especially in an outpatient setting. Ferric subsulfate (Monsel’s solution Mallinckrodt Baker Inc. USA) is widely used to achieve this task. Monsel’s solution is a topical agent with excellent styptic effect resulting from the breaking down of ferric ions and the agglutination of protein causing the small blood vessel to seal. Because of its styptic property it is frequently used in cervical dermatological and dental procedures. From the literature the published reports on Monsel’s solution concentrated mainly on hemostasis wound healing and the possible histologic nuisance. Patients’ concerns on the application of this chemical after cervical punch biopsy have never been addressed. In this study problems from the patients’ perspective were investigated. (excerpt)

Monsel's solution: a potential vector for nosocomial infection?

Monsel's solution is a common topically applied hemostatic agent used in minor dermatologic and gynecologic surgery. Clinically, because it is often stored for long periods and dispensed from a common source for multiple patients, Monsel's solution is a potential vector for transmission of infection. However, microbiologic inoculation studies and contamination surveys indicate that Monsel's solution has properties that prohibit microbial growth, making it an unlikely vector for nosocomial infection.

Can Monsel's Transmit Nosocomial Infections? A Microbiological Investigation

OBJECTIVE.: Our objective was to test whether common nosocomial pathogenic bacteria can be cultured in Monsel's paste, 20% ferric subsulfate, an astringent solution with styptic qualities that causes hemostasis when applied topically to small cuts. MATERIALS AND METHODS.: First, samples of Monsel's paste were collected and plated onto 4 media. Bacterial growth was evaluated at 48 hours. Second, thioglycollate medium was inoculated with a combination of Monsel's paste and actively growing stock bacteria. After 2 days, the samples were subcultured. They were evaluated for growth at 5 days. Next, samples of Monsel's were inoculated with 10Pseudomonas aeruginosa or 10Clostridium perfringens. The samples of inoculated paste were examined at 5-minute intervals thereafter to evaluate bacterial survival. RESULTS.: Neither the open samples of Monsel's solution nor the inoculated samples of Monsel's solution grew bacteria. When the samples inoculated with 10 organisms were examined at timed intervals after inoculation, no bacteria were noted after 5 minutes. CONCLUSIONS.: It is unlikely that nosocomial bacteria could survive exposure to Monsel's solution. Thus, potential contamination of the solution is unlikely, and subsequent transmission of infection is improbable.

Topical Haemostatic Agents: Avoid Multi-Use Containers

The Australian Journal of Hospital PharmacyVolume 30, Issue 5 p. 229-229 Letter to the EditorFree Access Topical Haemostatic Agents: Avoid Multi-Use Containers Fotios Ambados BPharm, Fotios Ambados BPharm Senior Pharmacist fotios.ambados@nwahs.sa.gov.au The Queen Elizabeth Hospital 28 Woodville Road, Woodville South SA 5011Search for more papers by this author Fotios Ambados BPharm, Fotios Ambados BPharm Senior Pharmacist fotios.ambados@nwahs.sa.gov.au The Queen Elizabeth Hospital 28 Woodville Road, Woodville South SA 5011Search for more papers by this author First published: 01 October 2000 https://doi.org/10.1002/jppr2000305229AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1Mc Murchie M. Contamination of multi-dose vials. Aust Fam Physician 1991; 20: 1207. 2Mortimer PP. Away with multi-use vials! AIDS 1999; 13: 1779– 81. 3Jetmore AB, Heryer JW, Conner WE. Monsel's solution: a kinder, gentler hemostatic. Dis Colon Rectum 1993; 36: 866– 7. 4Manca DP. Stopping cervical bleeding. Can Fam Physician 1997; 43: 2121. 5Ratliff CR. Preventing cervical bleeding with Monsel's solution. Oncol Nurs Forum 1992; 19: 664. Volume30, Issue5October 2000Pages 229-229 ReferencesRelatedInformation