WHAT THE EVIDENCE ABOUT THESE PRODUCTS MEANS FOR PRACTICE
Many products are available to help the ObGyn surgeon achieve hemostasis in tough situations. Most of the time, we face generalized oozing after treatment of extensive endometriosis or adhesiolysis; in these cases, older topical agents should serve us well. Patients who experience massive bleeding are not likely to benefit from the use of any of the products described in this article.
Extensive bleeding from uterine incisions—at cesarean section or after myomectomy—might respond to topical thrombin, platelet gel products, or tissue sealants, but these products have not been studied in our patients. They also are expensive and carry some risk for our patients.
Don’t overlook two strategies for extremely high-risk situations:
- Cell-saver technology can help avert transfusion in patients expected to lose a substantial amount of blood
- Intravenous recombinant activated factor VII (NovoSeven) can be life-saving for women who experience postpartum hemorrhage, placenta percreta, or retroperitoneal sarcoma and for whom our standard strategies have failed.—BARBARA S. LEVY, MD