Uterine packing with chitosan-covered gauze as management in primary postpartum hemorrhage in a humanitarian context in Middle East: A prospective evaluation

Principal investigator

Jihane Ben-Farhat

Location

Iraq
Topic

Maternal & womens health
Methodology

Cohort study: prospective
Reference

OCG026-10
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Purpose of study

Study status

Concept
Protocol & ERB
Implementation
Completion
Archived

Study timeline

Documents

1796-protocol-2025-08-01.docx 1.77 MB

Publications

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Purpose of study

The rationale for this study is grounded in the imperative to address the pressing healthcare needs of women experiencing PPH, a condition that poses significant risks to maternal health and well-being. Nowadays in case of PPH, therapy options vary with the degree of severity from medical therapy over uterine packing techniques to surgical measures: compressing sutures, selective devascularization and postpartum hysterectomy (HE), the last therapeutic resort associated with high morbidity and the loss of fertility (17,18). Recently, uterine packing with chitosan covered gauze (chitosan tamponade, CHT) has been introduced as a treatment option for PPH with very encouraging results, notably a reduction in 77,8% in PPH related hysterectomies (12). When used for PPH, uterine hemostatic tamponade involved the insertion of chitosan covered gauze through the vagina to effectively fill the uterine cavity until gentle resistance is encountered and bleeding is controlled in two ways: by pressure to uterine wall and by hemostatic propriety granules agents. Chitosan covered gauze is applied in uterine cavity when it confirmed that there are no placental remnants or clots left for up to 24 hours before removal. To the best of our knowledge, the use of chitosan-covered gauze for PPH management has not yet been adequately evaluated in humanitarian contexts or resource-limited settings. This study does not aim to validate the medical device itself - which is already approved and used in other settings - but to provide a structured and well-documented evaluation of its use in real-life humanitarian conditions. The goal is to inform future decision-making for similar contexts, where access to surgical interventions may be limited and maternal mortality remains high. The anticipated benefits of this approach extend beyond individual patients to broader healthcare systems and reproductive health services (SRH). By introducing a simple, easy-to-use technique that does not require specialized training, the study aims to offer healthcare providers an additional tool within the multipronged strategy for PPH response. By documenting the feasibility, outcomes, and operational considerations of using chitosan gauze in this setting, the study aims to support informed decisions about its future use in similar environments. Ultimately, this work seeks to contribute to the improvement of maternal care in contexts where resources are constrained and rapid, non-invasive solutions are critical.