The present disclosure relates to a hemostatic device, in particular intended to stop or reduce hemorrhages in a body cavity such as a uterus.
After childbirth, the mother's uterus is generally subjected to contractions that allow to stop the bleeding caused by the detachment of the placenta.
However, in some cases, the uterus may suffer from atony, so that such contractions do not occur or are not sufficient to stop bleeding, thereby generating a risk of maternal hemorrhage.
Various hemostatic devices have been developed to promote the contraction of the uterus and help stopping or reducing the hemorrhage.
Document EP 3 248 624 teaches a hemostatic device for treating postpartum hemorrhage, comprising a flat flexible plate presenting a pair of opposite faces configured to be placed in contact with a wall of the uterus and an empty internal volume in fluidic connection with a vacuum pump. Each face comprises a plurality of holes such that when a negative pressure is created in the internal volume by the pump, the walls of the uterus are attracted by the respective face of the plate and held together, which mechanically shrinks the uterus, thereby compacting the muscles forming the wall of the uterus and constricting the blood vessels to stop bleeding. However, the size of the uterus may vary from one patient to another one. It may be difficult to introduce the hemostatic device in a little uterus like a partially retracted uterus. It may thus be necessary to provide different formats of the hemostatic device to allow the practitioner to select the one fitting best the patient's uterus. In addition, the size of the uterus also decreases as the uterus contracts. Thus, once the uterus has attained the size of the flexible plate, the hemostatic device may hinder further contraction of the uterus.
Document WO 2020/123525 teaches a hemostatic device for treating postpartum hemorrhage, comprising a flexible portion configured to be inserted into the uterus, a seal configured to close the opening of the uterus, and a vacuum pump in fluidic connection with holes provided in the flexible portion. When the uterus is sealed, the pump creates a negative pressure within the uterus via the holes in order to facilitate contractile movement of the uterine wall and vessel constriction. In this device, various means may be provided to protect the holes from occlusion by tissues. Because of the shape of this hemostatic device, when it is in a uterus, the area of the uterine wall which is in contact with the hemostatic device is limited. Consequently, the hemostatic effect of the contact between the hemostatic device and a bleeding area of the uterus is limited. Moreover, the space remaining between the uterine wall and the hemostatic device allows the vacuum to escape from the neck of the uterus. In order to reduce this depression, an inflatable balloon is required which makes the hemostatic device complicated to use. Furthermore, the pressure applied in the area of the neck of the uterus can be excessive while the area of the neck of uterus is fragile and not very extensible.
There remains a need for a hemostatic device that can be easily inserted into a body cavity such as the uterus and conform to the shape of the cavity, while providing an efficient stimulation of the muscles forming the wall of the cavity and constriction of the blood vessels, without hindering further contraction of the uterus over time.
Some embodiments relate to a hemostatic device comprising at least one chamber delimited by a membrane, each chamber being configured to be fluidically connected to a vacuum source, the membrane being configured to be placed so as to face, at least partially, a bleeding area of a body cavity, the membrane comprising a plurality of holes leading into the chamber and configured to induce a negative pressure in the body cavity when a negative pressure is applied in the chamber by the vacuum source, the induced negative pressure being configured so that the walls of the cavity are attracted to the membrane, wherein the membrane has at least two opposite faces, each face comprising a plurality of folds extending in at least one first direction.
According to advantageous and non-limiting features, taken alone or in any combination:
The folds form a plurality of successive peaks and valleys extending on either side of a normal plane, wherein each side of the folds is oriented at an angle lower than 45° with respect to the normal plane.
Each side of the folds is oriented at an angle lower than 30° with respect to the normal plane.
The valleys of the first face are arranged so as to face the valleys of the second face.
At least part of the plurality of holes are located on the peaks.
Each face of the membrane extends according to a plane.
Each face of the membrane further comprises a plurality of folds extending in a second direction substantially perpendicular to the first direction so as to form a plurality of polyhedrons with a base having at least four sides.
The opposite faces of the membrane are linked in a linking area.
The holes are arranged in the membrane according to a constant pattern.
The membrane comprises two lateral sides connecting the two faces of the membrane, at least part of the plurality of holes of the plurality of holes being located on the lateral sides.
The hemostatic device comprises a single chamber configured to be fluidically connected to a vacuum source.
Each face of the membrane is closed on itself.
The hemostatic device has a trapezoidal shape.
The hemostatic device comprises a base comprising a primary channel configured to be connected to a vacuum source and to secondary channels, the secondary channels being fluidically connected to the chamber.
The base comprises holes leading to secondary channels.
The membrane is made of a flexible biocompatible polymer.
The hemostatic device is configured to be inserted in a uterus.
Further features and advantages will be described in the following description, based on the appended drawings, in which:
For the sake of legibility of the drawings, some components of the hemostatic device may have been omitted. In addition, the drawings are not necessarily drawn to scale.
In the drawings, identical reference signs designate elements that are identical to each other or that fulfil the same function. Thus, when one element has been described in detail with reference to one figure, it may not be described in detail again with reference to another figure.
The invention relates to a hemostatic device 1 configured to be inserted into a body cavity, such as a uterus, comprising a bleeding area.
The hemostatic device 1 comprises a membrane 4 provided with a plurality of folds 8, such that the hemostatic device 1 can have a plurality of positions comprising an expanded position and retracted positions. The expanded position corresponds to the position of the hemostatic device 1 when it is at rest, i.e. when the membrane 4 is not submitted to any force that could retract it. A retracted position corresponds to a position of the hemostatic device 1 when the folds 8 are brought closer to each other in at least one direction which is substantially orthogonal to the extension direction of the folds 8.
The hemostatic device 1 can be inserted into the body cavity when it is in a retracted position; then, due to the elasticity of the membrane 4, the hemostatic device 1 moves back to its expanded position to substantially fit the body cavity. The wall of the body cavity is attracted to the hemostatic device 1 due to the negative pressure induced in the body cavity by a vacuum circuit arranged into the hemostatic device 1, which causes bleeding to stop. The hemostatic device 1 can be moved back to a retracted position to extract the hemostatic device 1 from the body cavity.
In a particular embodiment, the hemostatic device 1 comprises a single chamber 2 adapted to be connected to the vacuum source. Thus, in the appended drawings and corresponding description, the hemostatic device 1 is illustrated with one chamber 2. However, it is understood that the hemostatic device can comprise more than one chamber 2, each chamber 2 being adapted to be connected to a common vacuum source or to distinct vacuum sources.
As illustrated in
Preferably, the hemostatic device 1 has a trapezoidal shape. The hemostatic device 1 can be seen as having the shape of a fan. Thus, in a side view like in
The membrane 4 comprises a plurality of holes 6 leading into the chamber 2. When a negative pressure is applied in the chamber 2 by the vacuum source, the holes 6 induce a negative pressure in the body cavity. Thus, the walls of the body cavity are attracted to the membrane 4.
Preferably, the holes 6 of the membrane 4 are arranged according to a constant pattern. Indeed, in order to guarantee the vacuum distribution, there is preferably not one cm2 of the membrane 4 which does not comprise a hole 6. Ideally, the holes 6 are equidistant from each other. Preferably, the holes 6 are arranged along lines. The holes 6 are at least arranged on the two opposite faces 4a, 4b of the membrane 4. Preferably, as illustrated in
There are approximately between 100 and 1000 holes 6 on the membrane 4. The diameter of the holes 6 is in the range of one millimeter.
The two opposite faces 4a, 4b of the membrane 4 comprise a plurality of folds 8 extending in at least one direction. Preferably, the folds 8 extend in a linear direction, from the upper side to the lower side. Preferably, each fold 8 extends in a distinct direction. Thus, the folds 8 do not extend in parallel directions. Indeed, as said, in a certain embodiment, the hemostatic device 1 has the shape of a fan. Consequently, the folds 8 flare out from the lower side of the membrane 4 to the upper side. Thanks to these folds 8, the hemostatic device 1 can be retracted (like a fan). As illustrated is
In a preferred embodiment, as illustrated in
According to an embodiment illustrated in
According to another embodiment illustrated in
According to yet another embodiment, the two opposite faces 4a, 4b of the membrane 4 are closed on themselves. Consequently, the two opposite faces 4a, 4b extend according to a respective curved surface closed on itself. This hemostatic device 1 has the advantage to better adapt to the shape of a body cavity such as a uterus.
As illustrated in
In other words, for each peak 9a and each valley, the sides 8a, 8b of the peak 9a/valley 9b have the same length and the angle between the bisector B of the angle formed by the peak 9a/valley 9b (between two sides 8a, 8b of the peak 9a/valley 9b) and each side 8a, 8b of the peak 9a/valley 9b is lower than 45°, preferably lower than 30° This geometrical structure prevents the hemostatic device 1 from being flattened because of the negative pressure applied into the hemostatic device 1.
Preferably, the holes 6 of the membrane 4 are arranged on the peaks 9a of the folds 8. When the hemostatic device 1 is in a body cavity, the peaks 9a are closer to the wall of the body cavity than the valleys 9b. Hence, the fact that holes 6 are arranged on the peaks 9a allows a better attraction of the wall to the membrane 4.
In a second embodiment illustrated in
Even if the polyhedron described here is a pyramid, it is understood that the polyhedrons can be other polyhedrons. For example, it can be pyramids with less facets, parallelepipeds.
It is understood that the top facet of a polyhedron corresponds to a peak 9a in the first embodiment with peaks 9a and valleys 9b. The lateral faces of the polyhedron correspond to the sides 8a, 8b of the folds 8 in the first embodiment with peaks 9a and valleys 9b.
Here again, as illustrated in
Preferably, the peaks 9a of the first opposite face 4a of the membrane 4 (and/or, in the embodiment with polyhedrons, the top facet of the polyhedron) face the peaks 9a of the second opposite face 4b of the membrane 4. Accordingly, the valleys 9b of the first opposite face 4a of the membrane 4 face the valleys 9b of the second opposite face 4b of the membrane 4. Consequently, the peaks 9a of the first opposite face 4a and the valley 9b of the second opposite face 4b cannot fit together such that the holes 6 of the first face cannot be blocked by the holes 6 of the second face 4b (and vice versa).
Furthermore, in a preferred embodiment, the opposite faces 4a, 4b of the membrane 4 are linked in a linking area so as to prevent the sliding of an opposite face 4a, 4b with respect to another. Indeed, if the faces 4a, 4b are allowed to slide, the peaks 9a of the first opposite face 4a and the valley 9b of the second opposite face 4b can fit together such that the holes 6 of the first face 4a can be blocked by the holes 6 of the second face 4b (and vice versa). This is highly unwanted. Thus, the faces 4a, 4b can be linked at some points inside the chamber 2 of the hemostatic device 1. For example, pillars can extend between the first opposite face 4a and of the second opposite face 4b. More precisely, pillars can extend between valleys 9b of the first opposite face 4a and valleys 9b of the second opposite face 4b.
Preferably, the hemostatic device 1 is made of a flexible biocompatible polymer such as silicone or other silicone-based elastomers, or thermoplastic elastomer (TPE) like thermoplastic polyurethane (TPU). The hemostatic device 1 can for example be made by moulding.
Preferably, to connect the hemostatic device 1 to the vacuum source, the hemostatic device 1 comprises a base 10 connected to the lower side 5d.
The base 10 comprises a plurality of holes of the base 18 which are fluidically connected to the primary inner channel of the base 10. More precisely, the holes of the base 18 are fluidically connected to the secondary inner channels 16 of the base 10 which are fluidically connected to the primary inner channel 14 of the base 10.
The base 10 can be a distinct element which is assembled to the rest of the hemostatic device 1, i.e. the part made of the membrane 4 defining the chamber 2. In a preferred embodiment, the base 10 and the membrane 4 form a single piece and both are moulded in the same mould.
A complete workflow of a treatment using the hemostatic device 1 will be described with reference to
In step S1, the hemostatic device 1 is prepared by the medical staff. The preparation includes in particular unpacking the hemostatic device 1 from its package and connecting the hemostatic device 1 to the vacuum source. Preferably, the vacuum source is connected to the opening 12 of the base 10 such that the vacuum source is fluidically connected to the primary channel 14 of the base 10.
In step S2, the hemostatic device 1 is inserted into the body cavity, for example the uterus. When the hemostatic device 1 is inserted into the body cavity, it is preferably retracted. The folds 8 of the device allow the retraction of the device in same manner of the retraction of a fan. Thus, the hemostatic device 1 is retracted in at least one direction which is orthogonal to the extension direction of at least one fold 8 and the sides 8a, 8b of the folds 8 are tightened to each other. The retraction is typically performed manually by the medical staff.
In step S3, the medical staff stops the manual retraction of the hemostatic device 1. The hemostatic device 1 expands itself in the body cavity. In other words, the membrane 4 expands until it substantially fits the body cavity. By “fits the body cavity”, it is meant that the membrane 4 substantially fits the shape and the size of the body cavity. By “substantially fit”, it is meant that according to the size of the body cavity, the membrane 4 may not perfectly fit the internal wall of the body cavity, i.e. some areas of the wall of the body cavity may not be in contact with the internal wall of the body cavity. Indeed, for example, the size and shape of the uterus may vary for every woman. Moreover, given the fact that the membrane 4 is folded, it is obvious that parts of the membrane 4 (especially the valleys 9b) are not in contact with the wall of the body cavity. However, providing that the membrane 4 substantially fits the body cavity allows maintaining the effectiveness of the hemostatic device 1 regardless of such variations in size and shape. At the end of the step S3, the membrane 4 faces, at least partially, a bleeding area of the body cavity.
It can be noted that to adapt to very different sizes of body cavities (such as a normal uterus and a small uterus), several sizes like two sizes of the hemostatic device 1 can be provided. For a patient, the choice of the more adapted hemostatic device 1 is made by the medical staff.
The structure of the hemostatic device 1 is particularly efficient because it expands autonomously in the body cavity. No positive pressure is necessary to make the hemostatic device 1 expand accordingly to the body cavity. Without any intervention, the hemostatic device 1 is well disposed into the body cavity. The positioning of the hemostatic device 1 is easy and fast.
In step S4, the vacuum source is turned on so that a depression is applied into the body cavity. Indeed, it is reminded that the chamber 2 of the hemostatic device 1, which is fluidically connected to the vacuum source, is fluidically connected to the body cavity through the holes 6.
In the embodiment according to which the hemostatic device 1 comprises a base 10, the vacuum source applies a depression into the body cavity via the primary channel 14 which is fluidically connected to the secondary channels 16, the secondary channels 16 being fluidically connected to the chamber 2. It is reminded that the base 10 can also comprise holes of the base 18. Thus, the depression is also applied into the body cavity via the holes of the base 18.
As a result, the wall of the body cavity is attracted by the membrane 4.
The level of vacuum applied, i.e. the negative pressure applied in the body cavity, depends on the clinical case. In the case of a uterus, if the uterus is capable of contracting again quite autonomously, it only needs to be incited to contract again and a low negative pressure is sufficient, for example a negative pressure of 10 mbar. However, if the uterus is atonic, an important negative pressure is necessary, for example a negative pressure of 1000 mbar.
Step S5 is a first stabilization step, in which the vacuum is maintained. Hemostasis is initiated by a dual action of the hemostatic device 1: (1) direct contact between the wall of the body cavity and the membrane 4 (and optionally the base 10) of the hemostatic device 1 (promoting a so-called “contact hemostasis”) and (2) compression of the wall of the body cavity and its internal structure by aspiration. Thanks to the fact that the holes 6 are arranged in a constant pattern, an even vacuum distribution can be ensured.
Moreover, during step S5, blood and bleeding tissues enter the chamber 2 via the holes 6. The blood and the bleeding tissues preferably circulate into the primary channel 14 and then into the secondary channels 16 of the base 10 to the opening 12. The blood and the bleeding tissues are evacuated via an atmospheric pump.
In step S6, the hemostatic device 1 retracts itself due to the vacuum applied in it. Indeed, once the wall of the body cavity is attracted to the holes 6 of the hemostatic device 1, the holes 6 are blocked by the wall and the vacuum is made into the chamber 2. Consequently, the hemostatic device 1 moves to a retracted position. Thanks to the specific structure of the membrane 4, the hemostatic device 1 retracts itself but is not flattened. Indeed, the hemostatic device 1 is allowed to retract in a direction normal to the first direction, i.e. the folds 8 are tightened and are closer to each other. It is reminded that this retraction is useful because the hemostatic can adapt to the variations of size of the body cavity (the variations can be due to the natural size of the body cavity which is different from a person to another and/or due to the variation of the body cavity which, as the uterus, can contract itself over time). However, the flattening of the hemostatic device 1 would be detrimental to hemostasis effect because the holes 6 of a face of the membrane 4 would be blocked by the other opposite face due to the fact that the opposite faces 4a, 4b of the membrane 4 would be stuck to each other. This could hinder the application of the depression into the body cavity. Such a situation can be avoided thanks to the geometrical structure of the membrane 4. Indeed, the folds 8 are made so that, for each fold 8, a first force F1 which is directed with respect to a normal plane N of the fold 8 (i.e. a F1 is a force encouraging the hemostatic device 1 to flatten) is lower than a second force F2 which is directed orthogonally to the first force F1 and the extension direction of the fold 8 (i.e. F2 is a force encouraging the hemostatic device 1 to retract). The first force F1 and the second force F2 are represented on
During step S6, the body cavity size decreases. The reduction of the size of the natural body cavity promotes the contraction of the muscles. These contractions compress the vessels and stop the bleeding permanently.
In step S7, the negative pressure is stopped, i.e. the vacuum source is turned off.
In step S8, the hemostatic device 1 is extracted from the body cavity. The extraction is typically performed manually by the medical staff who retracts manually the hemostatic device 1 to extract it. The medical procedure ends, after a minimal treatment time of 10 minutes for example, depending on the specific protocol.
Number | Date | Country | Kind |
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22305267.1 | Mar 2022 | EP | regional |
Filing Document | Filing Date | Country | Kind |
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PCT/EP2023/055802 | 3/7/2023 | WO |