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Torrential epistaxis in the third trimester: a management conundrum
  1. Rosa Elizabeth Mary Crunkhorn1,
  2. Alistair Mitchell-Innes2,
  3. Jameel Muzaffar3
  1. 1Queen Elizabeth Hospital, Birmingham, UK
  2. 2Department of ENT, Shrewsbury and Telford Hospitals, Telford, UK
  3. 3Department of Ear, Nose and Throat Surgery, Burton Hospital NHS Foundation Trust, Burton upon Trent, UK
  1. Correspondence to Alistair Mitchell-Innes, alistair.mitchell-innes{at}


Although epistaxis is common during pregnancy, large volume epistaxis is rare. Many standard epistaxis management options are limited in pregnancy due to absolute or relative contraindications. Ear, nose and throat surgeons need to be aware of what options can be used safely and effectively. We present a case of a 32-year-old woman, 32 weeks pregnant, who was admitted with heavy epistaxis refractive to conservative management. Several potential interventions including bismuth iodoform paraffin paste (BIPP) and Floseal were contraindicated or involved additional risk in pregnancy necessitating unorthodox management. This challenging case highlights suitable alternatives for managing large volume epistaxis during pregnancy, as well as discussing the differential diagnosis and relevant investigations.

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