Fibrin Sealant for Management of Complicated Obstetric Lacerations

BACKGROUND: Fibrin sealant commonly is used topically for hemostasis in cardiovascular surgery. Complicated vulvar and vaginal bleeding after vaginal delivery can be difficult to manage using traditional techniques. CASE: A 21-year-old primipara, after a spontaneous vaginal delivery of a twin gestation, was found to have expanding right labial swelling and ecchymosis extending from the superior part of the labia majora to the ischial fossa that was approximately 10 cm wide. Surgical exploration was pursued, but poor tissue quality limited the effectiveness of traditional hemostatic techniques. Prompt hemostasis was achieved with application of fibrin sealant. CONCLUSION: Fibrin sealant may be useful for hemostasis when traditional techniques fail in complicated lacerations of the vulva and vagina associated with obstetric delivery. (Obstet Gynecol 2070,115:403-4)