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

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 non-traditional use of Monsel’s 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’s 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.

Comparison of hemostatic efficacy and cytotoxicity of three ferric subsulfate- and chitosan-based styptics in different formulations using a rat tail bleeding model

“…Since the French pharmacist Leon Monsel pioneered the discovery of the styptic qualities of ferric subsulfate in 1852, ferric subsulfate has been used as a coagulative and hemostatic agent for minor surgical procedures in dermatology, dentistry, and gynecology [12,37]. Although the exact hemostatic mechanism of ferric subsulfate is still controversial, it is believed to be due to the denaturation and agglutination of blood proteins by ferric ions [29]. The reaction of blood with ferric and sulfate ions and the acidic pH of ferric subsulfate solution result in the agglutination of blood proteins, which then form plugs that occlude the capillary orifices [27,29].…”

“…Its low pH resists bacterial contamination [32]. However, ferric subsulfate may cause refractory pigmentation of skin and an inflammatory reaction that may persist for weeks at the site of damage [29].…”

Plasenta akreata olgusunda uterus koruyucu kare sütür uygulaması

“…Plasenta akreataya bağlı postpartum hemoraji kontrolünde alternatif bir yöntem olarak topikal hemostatik ajanların da kullanılabileceği bildirilmiştir. Monsel solüsyonunun fokal plasenta akreataya bağlı kanamanın tedavisinde etkili olabildiği bildirilmiştir (11). Postpartum kanamanın tedavisi ve maternal mortalite ve morbiditenin azaltılmasında en etkili yöntemin tanımlanması için daha ileride yapılacak kontrollü çalışmalara ihtiyaç vardır.…”

Genipin crosslinked microspheres as an effective hemostatic agent

“…In the clinical application, Quickclot has been found to have the risk of thermal injury, which greatly limits its application. Additionally, as the hemostatic material, Arista should be used with caution for diabetic patients, because it might increase glucose load.…”