Role of SURGISPON® in prevention of rectus sheath hematomas in anticoagulant patients/women after cesarean section

Introduction:

Cesarean deliveries, often referred to as C-sections, have become increasingly common worldwide. While these procedures are generally safe, they can occasionally lead to unexpected complications. One such complication that deserves attention is Rectus Sheath Hematoma (RSH), a condition that is not widely known but can have serious consequences if left untreated. Let’s delve into this lesser-known complication and understand its implications.

What is Rectus Sheath Hematoma?

Rectus Sheath Hematoma is a relatively rare condition characterized by the accumulation of blood within the rectus sheath, a fibrous structure surrounding the rectus abdominis muscle. This bleeding typically results from injury to the epigastric arteries or muscle tear, commonly caused by abdominal trauma or forceful muscle contractions during childbirth [1].

Anatomy of Rectus Sheath HematomaFig.1: Anatomy of Rectus Sheath Hematoma [Image Source: https://my.clevelandclinic.org/]

Understanding the Risk Factors:

Several factors can increase the risk of developing RSH, including:

  • Anticoagulant or antiplatelet therapy
  • Subcutaneous abdominal injections
  • Trauma
  • Strenuous physical activity
  • Surgery, particularly cesarean section
  • Pregnancy
  • Medical comorbidities

Of these, anticoagulant medications commonly used to prevent blood clots, significantly increase the risk of RSH. Studies have shown that individuals on anticoagulant therapy have a higher mortality rate associated with RSH, emphasizing the importance of recognizing this risk factor and taking preventive measures. [2].

However, there are strategies for managing RSH effectively. Tranexamic acid, a medication that promotes clotting, shows promise in controlling bleeding associated with RSH. Additionally, topical hemostatic agents such as Gelatin sponge (SURGISPON®; AEGIS LIFESCIENCES, India) can be valuable tools in managing bleeding during cesarean sections, particularly in cases where traditional surgical techniques may be insufficient. Gelatin Sponge is highly absorbent, expanding up to 200% in size and capable of absorbing 50 times its weight in blood or fluid. It can be shaped to fit the surgical site, becoming pliable when moistened, and is fully absorbed by the body within four weeks after application [3].

Clinical Study Insights:

A clinical trial with 63 pregnant women evaluated the effectiveness of using Gelatin sponge (SURGISPON®) soaked with tranexamic acid to prevent RHS following C-section in Warfarin-treated patients. The study found that this approach is safe and efficient in reducing postoperative drainage and blood loss, potentially lowering the risk of RHS and reducing the necessity for blood transfusion in high-risk women undergoing cesarean delivery [3].

Conclusion:

In summary, Rectus Sheath Hematoma (RSH) is a rare but serious complication of cesarean deliveries, especially in patients on anticoagulant therapy. Understanding its risk factors, such as abdominal trauma and medication use, is crucial for early detection and prevention. Promising treatments include tranexamic acid and Gelatin sponge, which have shown effectiveness in reducing bleeding and postoperative complications. Implementing these strategies can improve outcomes and minimize the risk of RSH in high-risk patients undergoing cesarean delivery.

References

1.Hirata Y, Kawamura H, Kato M, Ezaka Y, Yoshida Y. Rectus Sheath Hematoma Triggered by Post-cesarean Anticoagulant Therapy for Intraoperative Acute Pulmonary Thromboembolism: A Case Report. Cureus. 2023 Nov 18;15(11).doi: 10.7759/cureus.49034

  1. Dağ A, Ozcan T, Türkmenoğlu O, Çolak T, Karaca K, Canbaz H, Dirlik M, Sarıbay R. Spontaneous rectus sheath hematoma in patients on anticoagulation therapy. Ulus TravmaAcilCerrahiDerg. 2011 May 1;17(3):210-4.doi: 10.5505/tjtes.2011.84669
  2. Hany A, Mansour A, Sediek M, Nabil M. Role of tranexamic acid-soaked gelatin sponge in minimizing rectus sheath hematoma after cesarean section in women treated with warfarin, a simple tool for high-risk cases, a randomized controlled trial. European Journal of Medical Research. 2023 Oct 20;28(1):448. https://doi.org/10.1186/s40001-023-01434-7