Fletcher, Horace M.; Wharfe, Gillian H.; Mitchell, Sharmaine Y.; Simon,Theresa
Author Affiliation, Ana.
Department of Obstretics, Gynaecology and Child Health
Treatment of intractable vaginal bleeding with formaldehyde soaked packs
Journal of Obstretics and Gynaecology
Date of Publication
This, to our knowledge, is the first report in the literature using formaldehyde packs to stop intractable vaginal bleeding. Several authors have reported the use of formaldehyde instillation as a last resort to stop intractable bleeding (Fu, 1998; Counter, 1999;Adebamowo,2000). These cases have all reported success with this technique and none of these authors have reported any adverse effects with its use. In most cases they use a 4 per cent solution of formaldehyde. On the other hand, Giannakopoulos et al (1997) noted that when a 10 per cent solution of formaldhyde was instilled in the bladder of patients with massive haemmorage from inoperable bladder cancer, complications attributed to the formalin included decreased bladder capacity, retroperitoneal fibrosis, uninary incontinence, severe urinary frequency and nocturia. Sanrak et al (1999) have also written on the complications of intavesical formaldehyde especially ureteral reflux and renal failure. There are reports of animal studies with intrarectal formaldhyde in dogs, which looked at the absorption kinetics (Myers, 1997) and the mechanical, histological and biochemical effects of this compound (Myers, 1998). The authors found that when 4 per cent neutral buffered formaldehyde was instilled in a bolus dose of 100ml for 1 hour the serum levels of formic acid reached toxic levels within 15 minutes and remained elevated for 4 hours. This was not the case when 30 ml aliquot every 60 seconds, with removal, to a total of 400ml were used (Myers, 1997). The authors found further that there was no serious rectal injury or altered gastrointestinal function from the use of the formaldehyde (Myers,1998). From our limited experience, the use of formaldehyde soaked packs in the vagina appears to be safe. Although the concentration of formaldehyde we used appears to be high, this is the concentration of formalin kept as stock and readily available on most hospital wards. However, the amount of formaldehyde used is less than that reported during instillation techniques. The amount used is also much much less than that reported as being toxic in animal studies, and the absorption from the vagina is less effective than from the bladder and the rectum. The vagina, being lined with squamous cells, is also more durable than the rectum and bladder which are lined with secretory cells and transitional cells, respectively. It is important to emphasise the importance of determination of the underlying cause of intractable bleeding and the use of recognised modalities of definitive treatment to reverse these conditions, as was undertaken in these two cases with chemotherpy for the trophoblastic disease and factor replacement for DIC. Formaldehyde-soaked packs are therefore to be used as an adjunct to resuscitation and definitive treatment and as last resort where conventional packaging is successful.....