October 1st, 2014

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Title:
Gelatin-Thrombin Hemostatic Matrix in the Management of Placental Site Postpartum Hemorrhage: A Case Report
Authors:  C. T. Wohlmuth, M.D., and J. Dela Merced, M.D.
 
BACKGROUND: Gelatin-thrombin matrix (FloSeal, Baxter Healthcare Corporation, Fremont, California), a biodegradable hemostatic sealant, has been shown to control bleeding in multiple intraoperative scenarios and surgical disciplines. However, limited data is available regarding its use in obstetrics. A case of placental-site obstetric hemorrhage controlled with gelatin-thrombin matrix at time of cesarean delivery is presented.

CASE: A 28-year-old woman underwent a tertiary repeat cesarean delivery for complete placenta previa. The placenta was removed without evidence of placenta accreta. Profuse bleeding occurred over the placental implantation site, resulting in hemorrhage, uncontrolled by conservative uterine-sparing methods. Upon preparation for emergency hysterectomy, gelatin-thrombin matrix was applied, resulting in rapid control of hemorrhage.

CONCLUSION: Abnormal placentation is a predisposing factor of postpartum hemorrhage. In the absence of placenta accreta, profuse hemorrhage can occur from large vascular sinuses associated with a denuded implantation site in the poorly contractile lower uterine segment. In the event of unsuccessful hemorrhage control with conservative techniques, emergency hysterectomy is performed as a life-saving procedure. Multiple unit blood transfusion is often encountered. In the case presented, the use of gelatin-thrombin matrix gel for placental site hemorrhage management at the time of cesarean delivery resulted in rapid control of hemorrhage, uterine preservation and avoidance of massive blood transfusion.
Keywords:  FloSeal Matrix; gelatin sponge, absorbable; gelatin-thrombin hemostatic matrix; hemorrhage, postpartum; immediate postpartum hemorrhage
   
   
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