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Am J Obstet Gynecol. 2015 Jun;212(6):725-35. doi: 10.1016/j.ajog.2014.12.029. Epub 2015 Jan 8.

Use of Monsel solution to treat obstetrical hemorrhage: a review and comparison to other topical hemostatic agents.

Author information

1
Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT.
2
University of Maryland School of Medicine, Baltimore, MD.
3
Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT. Electronic address: alessandro.santin@yale.edu.

Abstract

Peripartum hemorrhage accounts for 8% of maternal deaths in the United States, and nearly 27% worldwide. A growing need exists for tactics to spare morbidity given a rise of abnormal placentation that contributes to excessive blood loss at the time of delivery. Approaches such as compression sutures, balloon tamponade, and pelvic artery embolization are not without side effects and potential implications for future fertility. The use of topical hemostatic agents has become widespread in gynecologic and obstetric surgery despite a paucity of distinct studies in the field, and may allow providers to increasingly avoid cesarean hysterectomy. A variety of topical hemostatic agents exist along a wide cost continuum, each characterized by specific efficacy, advantages, drawbacks, and often gaps in long-term data to support safety and impact on future fertility. Herein, we comprehensively review these agents and illustrate a nontraditional use of Monsel solution applied directly to the placental bed in a case of focal placenta accreta. This ultimately contributed to successful uterine preservation with no known adverse sequelae. Monsel solution may have a role in establishing hemostasis in the setting of abnormal placentation, and may be a particularly attractive alternative in resource-poor nations.

KEYWORDS:

Monsel solution; hemostatic agent; peripartum hemorrhage; placenta accrete

Comment in

PMID:
25577672
PMCID:
PMC4457701
DOI:
10.1016/j.ajog.2014.12.029
[Indexed for MEDLINE]
Free PMC Article

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