Chitosan-Covered Tamponade for Postpartum Hemorrhage: A Structured Narrative Review of Clinical Evidence

Background/Objectives: Postpartum hemorrhage (PPH) remains a leading cause of maternal death. This review summarizes clinical evidence on chitosan-covered tamponade (CCT), distinguishing mechanistic rationale from demonstrated clinical benefit. Methods: A structured narrative review following SANRA recommendations used updated PubMed, Scopus, and Web of Science records (publication years 2000–2026; October 2026 update). Results were synthesized descriptively. Results: Twelve clinical publications concerned PPH; two reports of other obstetric hemorrhage were retained separately for context, and six safety publications were catalogued. In a single uncontrolled registry cohort (n = 230), hemorrhage control without further invasive procedures was reported in 210 women (91.3%). Separately, vaginal or vulvar CCT controlled lower genital tract trauma bleeding in 25/26 women; these findings do not establish intrauterine effectiveness. Retrospective balloon comparisons do not establish equivalence or non-inferiority. Historical hysterectomy findings are vulnerable to confounding. Six PPH publications originated from one institution, with possible patient overlap. No direct comparison with conventional gauze was identified, and reports of ocular and audiovestibular inflammation raise safety concerns. Conclusions: A clinical advantage over conventional gauze has not been demonstrated. Current international PPH guidance remains applicable and does not recommend uterine packing with plain or hemostatic-agent-impregnated gauze. Comparative effectiveness and safety require prospective evaluation before routine CCT use can be supported.