Retained Vaginal Gauze: What to Do

Immediate steps

1. Try to locate and remove it yourself only if it is low and easily reachable - wash your hands thoroughly, and gently try to feel for and grasp it with clean fingers. If you can't feel it, can't grasp it, or it's been in place for more than a few hours to a day, stop trying and see a doctor or go to an emergency/urgent care/gynecology clinic. Never use another object (tweezers, tools) to try to fish it out - this risks pushing it further in or causing trauma.
2. See a clinician promptly for removal. This is a quick office/ED procedure:
   • Speculum exam to visualize the vagina and cervix
   • Direct removal with ring forceps or similar instrument
   • The vagina is then usually irrigated, and the cervix/vaginal walls checked for any injury or ulceration caused by prolonged pressure
3. Antibiotics may be given if there are signs of infection (foul odor, purulent discharge) or if the gauze has been retained for an extended period.

Why it matters - don't delay

• Foul-smelling discharge and vaginitis are the most common consequences of a retained vaginal foreign body.
• Toxic Shock Syndrome (TSS) is the serious concern - it's caused by toxin-producing Staphylococcus aureus (or sometimes Streptococcus pyogenes) that can proliferate on retained gauze/packing material. TSS presents with sudden high fever, a diffuse rash, low blood pressure, vomiting/diarrhea, and can progress to multi-organ failure - it's a medical emergency.
• Prolonged retention can also cause pressure ulceration, bleeding, or local tissue erosion.

Red flags - seek emergency care immediately if you have

• High fever, chills
• A sunburn-like rash
• Dizziness, fainting, or very low blood pressure
• Severe abdominal pain, vomiting, or diarrhea
• Confusion

1. Removal (the definitive treatment)

• See a clinician (gynecologist, emergency physician, or GP) as soon as possible - do not delay.
• Removal is usually simple: a speculum exam is done, and the gauze is grasped with ring forceps or a Kelly clamp and withdrawn. No anesthesia is typically needed for a straightforward case.
• If the gauze has been in place for a long time, is deeply embedded, or is stuck to inflamed/friable tissue, removal may need to be done in an operating room.
• Never try to remove it yourself with another object (fingers alone are usually fine if you can reach and feel it, but instruments increase injury risk) - this can cause lacerations or push it in further.
• After removal, the vaginal walls are inspected for lacerations, ulceration, or embedded fibers. Any bleeding laceration is tamponaded with a dressing and, if deep, repaired surgically (Roberts and Hedges' Clinical Procedures in Emergency Medicine, p. 1381).

2. Assess for infection / Toxic Shock Syndrome

• High fever, chills
• Diffuse rash, later skin peeling (especially palms/soles)
• Hypotension, dizziness, fainting
• Vomiting, diarrhea
• Muscle aches, confusion

• Immediate removal of the foreign body (source control)
• IV fluids and vasopressor support if hypotensive
• Empiric IV antibiotics covering staph/strep (e.g., a beta-lactam plus clindamycin, which also suppresses toxin production)
• Hospital admission, sometimes ICU-level care

3. If no systemic infection, just local findings

• Foul-smelling discharge, vaginitis, or mild irritation from a retained gauze usually resolves quickly once it's removed.
• A short course of antibiotics may be given if there's evidence of local infection or vaginitis, though often none is needed once the foreign body is out.
• Follow-up exam to confirm healing, especially if there was a laceration.

4. Practical notes

• Don't wait "to see if it comes out on its own" - retained material can migrate, become embedded, or lead to chronic infection/fistula formation if left for weeks.
• Bring up how it was placed and how long it has been there (e.g., post-partum packing, post-op packing) so the clinician can assess infection risk and rule out that additional gauze pieces weren't left behind.
• If this occurred after a surgery or delivery at a hospital, that facility should be notified, as retained surgical items are tracked as a safety event and they may need to check for any other missed materials.