Fibrin Sealant for Management of Complicated Obstetric Lacerations

Whiteside, James L.; Asif, Rehan; Novello, Renee J.

doi:10.1097/aog.0b013e3181bb1e28

Cited by 19 publications

(7 citation statements)

References 4 publications

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“…Over the last decade, a number of surgical sealants have been introduced for prevention and reduction of air leaks. 7 These include naturally occurring proteins, such as fibrin-based sealants [8][9][10] and collagen fleece-bound sealants; [11][12][13][14] and synthetic sealants including cyanoacrylates and polyethylene glycol (PEG)-based compounds. [15][16][17] Although fibrin and collagen sealants effectively promote wound healing, much like their natural role in clot formation, there are serious concerns about blood-borne virus contamination (e.g.…”

Section: Introductionmentioning

confidence: 99%

Synthesis and characterisation of poly(glycerol sebacate)-co-lactic acid as surgical sealants

2011

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Surgical sealants are currently used in conjunction with sutures to reduce the incidence of air or fluid leaks. Although fibrin and collagen sealants can effectively promote wound healing, there are serious concerns about blood-borne virus contamination. Hence, synthetic sealants have been considered a safer alternative. In this work, a new family of synthetic surgical sealant copolymers were derived from poly(glycerol sebacate) (PGS) and lactic acid (LA). The newly developed PGS-co-LA tissue sealants had significantly higher adhesive strength than either fibrin sealants or synthetic PleuraSealÔ. Secondly, the addition of lactic acid to PGS significantly improved the cytocompatibility of the materials, compared with pure PGS. Thirdly, the new sealants were able to be pasted in liquid form at $45 C, which subsequently solidified into a soft wax-like patch at body temperature. These properties make the PGS-co-LA materials promising candidates for soft tissue sealants.

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Section: Introductionmentioning

confidence: 99%

Synthesis and characterisation of poly(glycerol sebacate)-co-lactic acid as surgical sealants

2011

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“…This was controlled with intrauterine, vaginal application of GTM and recombinant activated human factor VIIa transfusion ( 43 ) . Finally, GTM proved successful in a woman with post-partum hemorrhage due to vaginal laceration that could not be controlled using traditional techniques due to “poor tissue quality” ( 44 ) . Similar cases of bleeding from a caesarean scar ( 45 ) and placental site ( 46 , 47 ) were controlled with GTM.…”

Section: Introductionmentioning

confidence: 99%

Use of a gelatin-thrombin hemostatic matrix in obstetrics and gynecological surgery

Misirlioğlu

Türkgeldi

Yağmur

et al. 2018

tjod

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Gelatin-thrombin matrix (GTM) is a hemostatic sealant consisting of bovine-derived gelatin matrix and human-derived thrombin, combining both mechanical and active mechanisms to achieve hemostasis. It was approved by the Food and Drug Administration in 1999. GTM has been used by several surgical specialties; however, it is a possibly an under-used tool in obstetrics and gynecology. A limited number of studies have been performed on its use during laparoscopic endometrioma excision and myomectomy. It may prove useful in endometrioma excision in reproductive aged women because it is likely to harm ovarian reserve less than electrocautery; however, this conclusion needs to be validated. The only study on GTM use in myomectomy included 50 women randomized into GTM and control groups, and showed decreased blood loss and shorter hospital stays in the GTM group. In gynecologic oncology, it was successfully used to reduce lymphocele cases in a cohort study. GTM has been used successfully in obstetrics in a handful of cases of uncontrolled bleeding from caesarean scar, placental site, ectopic pregnancy, rectovaginal hematoma, and venous plexus over the vaginal vault after emergency postpartum hysterectomy. Risk of viral transmission is a major concern about GTM, yet there are no reports on disease transmission with GTM use to date. Rare but serious adverse effects and complications have been reported such as fatal or near-fatal thromboembolism and small bowel obstruction. Although GTM is mostly a safe product, it is still not free of complications and risks. In conclusion, although routine use of GTM cannot be recommended due to concerns about its safety, cost, and availability, it may prove useful when conventional hemostatic methods such as suturing and electrocauterization fail or are not appropriate.

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“…Although most applications of topical hemostatic agents occur at the time of cesarean section or hysterectomy, they have also been used to control hemostasis from vaginal and vulvar lacerations that occur following traumatic vaginal deliveries [37].…”

Section: Obstetrical Usagementioning

confidence: 99%

Biologic Hemostatic Agents in Obstetrics and Gynecology

Patriarco¹,

Shenoy²,

Taylor³

2021

Contemporary Applications of Biologic Hemostatic Agents Across Surgical Specialties - Volume 2 [Working Title]

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In Obstetrics and Gynecology, the practice of biologic hemostatic agents in the field are generally used to augment the basic tenets of hemostasis to decrease the morbidity and mortality of such procedures. These hemostatic agents work along with the body’s physiology to rapidly aid in platelet plug formation, activation of the clotting cascade, the creation of fibrin, and to form a stable clot. The four main sub-categories of hemostatic agents include mechanical, biological, flowable, and fibrin sealants. Mechanical agents act as scaffolding for platelet aggregation to form a platelet plug. Biological agents activate clotting factors in the coagulation cascade to aid in hemostasis. Flowable agents combine biologic with mechanical agents to stabilize clot formation while also providing mechanical tamponade. Fibrin sealants combine high levels of fibrin and thrombin that when combined, form a fibrin clot at an accelerated speed. Hemostatic agents in obstetrics are often used in the setting of postpartum hemorrhage, cesarean delivery and postpartum hysterectomy to decrease the rate of morbidity most commonly seen with abnormal placentation and uterine atony. With gynecologic surgery, hemostatic agents are more commonly used then in obstetrics. They aid in hemostasis with common gynecologic procedures including hysterectomies, ovarian cystectomies, myomectomies, endometriosis cases, incontinence procedures and malignant debulking procedures. Also, with the increase in minimally invasive surgical techniques, topical hemostasis can aid in fewer transfusions, improved visualization in the surgical field decreased operative time and reduction in the risk of conversion to laparotomy.

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Fibrin Sealant for Management of Complicated Obstetric Lacerations

Abstract: Fibrin sealant may be useful for hemostasis when traditional techniques fail in complicated lacerations of the vulva and vagina associated with obstetric delivery.

Cited by 19 publications

References 4 publications

Synthesis and characterisation of poly(glycerol sebacate)-co-lactic acid as surgical sealants

Synthesis and characterisation of poly(glycerol sebacate)-co-lactic acid as surgical sealants

Use of a gelatin-thrombin hemostatic matrix in obstetrics and gynecological surgery

Biologic Hemostatic Agents in Obstetrics and Gynecology

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