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Kwong LT, Wong SF, So PL. Menstrual, fertility and psychological impacts after uterine compression sutures for postpartum hemorrhage: a prospective cohort study. BMC Pregnancy Childbirth 2023; 23:217. [PMID: 36991358 DOI: 10.1186/s12884-023-05530-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/20/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Uterine compression suture is an important conservative surgical technique in managing atonic postpartum hemorrhage. In this study, we aim to evaluate the subsequent menstrual, fertility and psychological outcomes after uterine compression sutures. METHODS This was a prospective cohort study between 2009 and 2022 conducted in a tertiary obstetric unit (6000 deliveries per year) in Hong Kong SAR. Women with primary postpartum hemorrhage successfully treated with uterine compression sutures were followed-up in postnatal clinic for two years after delivery. Data on menstrual pattern were collected during each visit. Psychological impact after uterine compression suture was assessed using a standardized questionnaire. Subsequent pregnancies were identified by territory-wide computer registry and telephone interviews. Women with postpartum hemorrhage treated with uterotonic agents only were chosen as controls. RESULTS In our cohort (n = 80), 87.9% of women had return of menses within six months after delivery. Regular monthly cycle was observed in 95.6% of women. Majority of women reported similar menstrual flow (75%), menstrual days (85.3%) and no change in dysmenorrhea status (88.2%) as compared before. Among eight (11.8%) women who reported hypomenorrhea after uterine compression sutures, two cases of Asherman's syndrome were diagnosed. Among 23 subsequent pregnancies (16 livebirths), no significant differences in outcome were observed except more omental or bowel adhesions (37.5% vs. 8.8%, p = 0.007), recurrence of hemorrhage (68.8% vs. 7.5%, p < 0.001) and repeated compression sutures (12.5% vs. 0%, p = 0.024) were seen in women with previous compression sutures. Over half of the couple declined future fertility after uterine compression sutures with 38.2% of women recalled unpleasant memories and 22.1% reported life-long adverse impact especially tokophobia. CONCLUSION Majority of women with history of uterine compression sutures had similar menstruation and pregnancy outcomes as compared to those who did not have sutures. However, they had higher intrapartum risk of visceral adhesions, recurrence of hemorrhage and repeated compression sutures next pregnancy. Furthermore, couple could be more susceptible to negative emotional impact.
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Affiliation(s)
- Lee Ting Kwong
- Department of Obstetrics and Gynecology, Tuen Mun Hospital, Tuen Mun, Hong Kong.
| | - Sai Fun Wong
- Department of Obstetrics and Gynecology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Po Lam So
- Department of Obstetrics and Gynecology, Tuen Mun Hospital, Tuen Mun, Hong Kong
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Matsubara S. Uterine compression suture: Some procedures to reduce necrosis or synechia. Acta Obstet Gynecol Scand 2023; 102:396-397. [PMID: 36680326 PMCID: PMC9951335 DOI: 10.1111/aogs.14510] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/07/2023] [Accepted: 01/09/2023] [Indexed: 01/22/2023]
Affiliation(s)
- Shigeki Matsubara
- Department of Obstetrics and GynecologyJichi Medical UniversityTochigiJapan,Department of Obstetrics and GynecologyKoga Red Cross HospitalKogaJapan
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Xia L, Lin J, Dai Y, Wang X. Study on the application of King's combined uterine suture for hemostasis during cesarean section. BMC Pregnancy Childbirth 2021; 21:762. [PMID: 34758779 PMCID: PMC8579605 DOI: 10.1186/s12884-021-04231-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/26/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Postpartum hemorrhage is a serious complication of childbirth and is still the leading cause of maternal death worldwide. Lower uterine segment hemorrhage during cesarean section is an important cause of postpartum hemorrhage. Our objective is to expore the efficacy and safety of King's combined uterine suture for hemostasis during cesarean section. METHODS We examined 48 cases: 16 cases of pernicious placenta previa (including one case of twins), 11 cases of central placenta previa (including one case of twins), 18 cases of uterine scarring (including two cases of twins), as well as one case of twin pregnancy, two cases of breech presentation, and one case of pulmonary hypertension. The "King's combined uterine suture" method for hemostasis was used in patients with lower uterine segment hemorrhage during cesarean section. RESULTS The results showed that all patients had successful hemostasis during surgery, and there were no cases of hysterectomy. CONCLUSION We have concluded that King's combined uterine suture is a fast and safe hemostasis method for cesarean section that can effectively reduce blood loss and restore the normal shape of the lower uterine segment. Furthermore, this suture method can reduce postpartum hemorrhage and hysterectomy rate, as well as improve maternal prognosis.
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Affiliation(s)
- Li Xia
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001 Fujian China
| | - Jinxiao Lin
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001 Fujian China
| | - Yan Dai
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001 Fujian China
| | - Xinrui Wang
- Medical Research Center, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001 Fujian China
- Fujian Key Laboratory of Women and Children’s Critical Diseases Research, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001 Fujian China
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Li GT, Li XF, Li GR, Wu BP, Zhang XL, Xu HM. Removable retropubic uterine compression suture for controlling postpartum hemorrhage. J Obstet Gynaecol Res 2021; 47:1337-1343. [PMID: 33590596 DOI: 10.1111/jog.14698] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 01/14/2021] [Accepted: 01/29/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To minimize the adverse events of uterine compression suture in controlling postpartum hemorrhage (PPH) and to search for a prophylactic approach to potential PPH. METHODS A retrospective analysis was performed in 39 women with removable retropubic uterine compression suture (RRUCS) to stop PPH due to uterine atony during cesarean section (CS). The procedure was to suspend and compress the uterus to the retropubic abdominal wall using an absorbable suture. RESULTS The technique was sufficient to stanch bleeding immediately in 36 patients (92.31%, 36/39). No morbidity or abnormalities occurred in women who underwent RRUCS. Subsequent pregnancies occurred in 10 cases, but the others lacked the desire for future pregnancy. CONCLUSION RRUCS is a simple, safe, and effective technique in controlling atonic PPH; it is also used as a prophylactic application in patients with potential PPH after CS.
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Affiliation(s)
- Guang-Tai Li
- Department of Obstetrics and Gynecology, Hebei Yanda Hospital, affiliated to Hebei Medical University, Beijing, China.,Department of Obstetrics and Gynecology, China Meitan General Hospital (Emergency General Hospital), Beijing, China
| | - Xiao-Fan Li
- Department of Radiation Oncology, Peking University School of Oncology, Peking University Cancer Hospital, Beijing, China
| | - Guang-Rui Li
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Bao-Ping Wu
- Department of Obstetrics and Gynecology, China Meitan General Hospital (Emergency General Hospital), Beijing, China
| | - Xiu-Lan Zhang
- Department of Obstetrics and Gynecology, Sanya City Womenfolk and Infant Health Care Hospital, Sanya City, China
| | - Hong-Mei Xu
- Department of Obstetrics and Gynecology, Beijing Fengtai Hospital, affiliated Capital Medical University, Beijing, China
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Alves ÁLL, Nagahama G, Nozaki AM. Surgical management of postpartum hemorrhage. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2020; 42:679-686. [PMID: 33129225 DOI: 10.1055/s-0040-1719159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Matsubara S. A novel uterine stent for preventing intrauterine adhesion: not only gynecologic but also obstetric significance. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:614. [PMID: 32566551 PMCID: PMC7290640 DOI: 10.21037/atm.2020.03.65] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Shigeki Matsubara
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan
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New dedicated blunt straight needles and sutures for uterine compression sutures: a retrospective study and literature review. BMC Surg 2019; 19:33. [PMID: 30866898 PMCID: PMC6417176 DOI: 10.1186/s12893-019-0495-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/01/2019] [Indexed: 11/16/2022] Open
Abstract
Background We developed a dedicated blunt straight needle with No. 2 polydioxanone sutures (2-Monodiox®) for uterine compression sutures (UCSs) and aimed to assess the outcomes and complication rates of UCSs for postpartum hemorrhage by comparing with commercially available needle and suture types. Methods A retrospective analysis was performed between January 2010 and February 2018. During the study period, two types of commercially available sutures and 2-Monodiox® were used. PubMed, MEDLINE, and Scopus databases were searched for English articles published between January 1997 and May 2017 using search terms related to the suture and needle types for UCSs to discuss the dedicated needles and sutures for UCS. Results The analysis included 47 cases of UCSs for the uterine body with three suture types (No. 0 polydioxanone, 7 cases; No. 1 poliglecaprone 25, 21 cases; and No. 2 polydioxanone, 19 cases). B-Lynch suture using No. 0 sutures was associated with a significantly lower uterine preservation rate than those with Nos. 1 and 2 sutures (42.9% vs. 95.2 and 89.5%, respectively; p < 0.01). A modified Hayman suture technique was performed using 2-Monodiox® sutures, which achieved a similar uterine preservation rate compared with B-Lynch suture using No. 1 poliglecaprone 25 sutures. No patients developed severe complications. The literature review showed that no dedicated sutures have developed for UCSs. Three dedicated needles for UCSs have been developed, and 2-Monodiox® is the first dedicated blunt straight needle for UCSs. Conclusion Our data showed that No. 0 sutures should not be used for B-Lynch suture. The uterine preservation rate is similar for 2-Monodiox® with modified Hayman suture and No. 1 poliglecaprone 25 sutures with B-Lynch suture, without the occurrence of severe complications. Electronic supplementary material The online version of this article (10.1186/s12893-019-0495-7) contains supplementary material, which is available to authorized users.
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Li GT, Li XF, Lu Y, Li GR, Xu HM. Response to ‘Letter to “Ring compression suture for controlling post-partum hemorrhage during cesarean section”: Some additions’. J Obstet Gynaecol Res 2018; 45:242-244. [PMID: 30353602 DOI: 10.1111/jog.13843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 09/23/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Guang-Tai Li
- Department of Obstetrics and Gynecology; China Meitan General Hospital; Beijing China
| | - Xiao-Fan Li
- Department of Radiation Oncology; Peking University School of Oncology, Peking University Cancer Hospital; Beijing China
| | - You Lu
- Pharmaceutical Preparation Section; China Meitan General Hospital; Beijing China
| | - Guang-Rui Li
- Department of Venereology; Wangjing Hospital, China Academy of Chinese Medical Sciences; Beijing China
| | - Hong-Mei Xu
- Department of Obstetrics and Gynecology; Beijing Fengtai Hospital, Affiliated to Capital Medical University; Beijing China
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Shih JC, Liu KL, Kang J, Yang JH, Lin MW, Yu CU. 'Nausicaa' compression suture: a simple and effective alternative to hysterectomy in placenta accreta spectrum and other causes of severe postpartum haemorrhage. BJOG 2018; 126:412-417. [PMID: 30009547 PMCID: PMC6585672 DOI: 10.1111/1471-0528.15410] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2018] [Indexed: 01/09/2023]
Abstract
Postpartum haemorrhage (PPH), especially resulting from placenta accreta spectrum (PAS), has become a worldwide concern in maternity care. We describe a novel method of uterine compression sutures (the ‘Nausicaa’ technique) as an alternative to hysterectomy for patients who have suffered from major PPH. We applied this technique in 68 patients with major PPH during caesarean section (including 43 patients with PAS, 20 patients with placenta praevia totalis, and five patients with uterine atony), and none of these patients required further hysterectomy. We conclude that our Nausicaa suture is a simple and feasible alternative to hysterectomy in patients suffering from major PPH.
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Affiliation(s)
- J-C Shih
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - K-L Liu
- Department of Radiology, National Taiwan University Hospital Taipei, National Taiwan University College of Medicine, Taipei, Taiwan
| | - J Kang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - J-H Yang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - M-W Lin
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - C-U Yu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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Matsubara S, Takahashi H, Yano H. Letter to 'Ring compression suture for controlling post-partum hemorrhage during cesarean section': Some additions. J Obstet Gynaecol Res 2018; 44:2016-2017. [PMID: 30015366 DOI: 10.1111/jog.13749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Shigeki Matsubara
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan
| | - Hironori Takahashi
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan
| | - Hitoshi Yano
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan
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11
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Intentional placental removal on suspicious placenta accreta spectrum: still prohibited? Arch Gynecol Obstet 2017; 297:1-2. [PMID: 29151230 DOI: 10.1007/s00404-017-4592-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 11/10/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Intentional placental removal for abnormally invasive placenta (AIP) is fundamentally abandoned at planned surgery for it. Whether this holds true even after recent introduction of various hemostatic procedures is unclear. MATERIALS AND METHODS We discussed on this issue based on our own experiences and also on the recent reports on various hemostatic procedures. RESULTS Studies directly answering this question have been lacking. We must weigh the balance between the massive bleeding and possibility of uterus-preservation when intentional placental removal strategy is employed. CONCLUSION An almost forgotten strategy, the "intentional placental removal" for planned AIP surgery may regain its position when appropriate hemostatic procedures are concomitantly used depending on the situation. Even employing this strategy, quick decision to perform hysterectomy under multidisciplinary team may be important.
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Seidel V, Braun T, Chekerov R, Nonnenmacher A, Siedentopf JP, Henrich W. Vaginal omentum prolapse due to uterine anterior wall necrosis after prophylactic compression suture for postpartum hemorrhage: case report and review of the literature. CASE REPORTS IN PERINATAL MEDICINE 2017. [DOI: 10.1515/crpm-2016-0074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Introduction
Postpartum or peripartum hemorrhage (PPH) is a major cause of maternal death in Western industrialized countries. Fertility preserving second stage interventions following uterotonic drugs include embolization or ligation of relevant arteries, uterine tamponade or compression sutures. Little is known about the complications due to uterine compression sutures. We describe a case report in association with uterine compression sutures and provide a systematic review on necrosis due to compression sutures (CSU).
Data sources
A PubMed database search was done up to October 1, 2016 without any restrictions of publication date or journal, using the following key words: “compression suture” and “postpartum hemorrhage” or “peripartum hemorrhage”. Reported cases were considered eligible when reason for postpartum hemorrhage (PPH), type of compression suture, suture material and type of complication were described.
Results
Among 199 publications a total of 11 reported on uterus necrosis after CSU applied for PPH. B-Lynch and modifications were applied in seven cases, Cho compression sutures in three cases and in one case B-Lynch and Cho techniques were combined. In six cases no additional measures were applied, in two cases vessel ligation, in one case embolization and in one case intrauterine balloon application were applied. In one case of partial necrosis it is not reported if additional measures were applied.
Discussion and conclusion
Uterine compression sutures are a useful method for fertility preserving management of postpartum hemorrhage. The risk of serious complications demands the careful consideration of its use. More research is necessary to improve the technique.
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Zhang ZW, Wang T, Guo W, Wang L, Zhang GX. Author's reply re: Removable uterine compression sutures for postpartum haemorrhage: two questions. BJOG 2016; 123:1559-60. [PMID: 27440598 DOI: 10.1111/1471-0528.13947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Z W Zhang
- Department of Obstetrics, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - T Wang
- Department of Obstetrics, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - W Guo
- Department of Obstetrics, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - L Wang
- Department of Obstetrics, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - G X Zhang
- Department of Obstetrics, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
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Takeda J, Kumakiri J, Makino S, Itakura A, Takeda S. Laparoscopic removal of uterine vertical compression sutures. Gynecol Minim Invasive Ther 2016; 6:73-75. [PMID: 30254880 PMCID: PMC6113968 DOI: 10.1016/j.gmit.2016.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 03/04/2016] [Accepted: 03/23/2016] [Indexed: 11/05/2022] Open
Abstract
Uterine compression suturing is a relatively easy and effective way of hemostasis during cesarean section and is becoming widely accepted. However, complications such as necrosis or synechiae have been reported. We firstly report a case of laparoscopic removal of vertical compression sutures and discuss its benefits and improvements to be made. This case report is of a 32-year-oId woman with placenta previa who received uterine vertical compression sutures for controlling massive bleeding during cesarean section. Because she complained of unbearable pelvic pain, laparoscopic compression suture removal was performed. Her pain was relieved after the threads were removed, suggesting that the compression sutures were the cause of her pelvic pain due to uterine ischemia. Although the risks of reoperation during the early postpartum period still exist, compression suture thread removal should be considered in cases of suspected uterine ischemia.
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Affiliation(s)
- Jun Takeda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Jun Kumakiri
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Shintaro Makino
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Atsuo Itakura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Satoru Takeda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
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Comment on "Alternate Sequential Suture Tightening: A Novel Technique for Uncontrolled Postpartum Hemorrhage". Obstet Gynecol Int 2015; 2015:279513. [PMID: 26265917 PMCID: PMC4523652 DOI: 10.1155/2015/279513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/05/2015] [Indexed: 11/20/2022] Open
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Matsubara S, Takahashi H, Lefor AK. A Commentary on: "A New Removable Uterine Compression by a Brace Suture in the Management of Severe Postpartum Hemorrhage". Front Surg 2015; 2:17. [PMID: 26029699 PMCID: PMC4429487 DOI: 10.3389/fsurg.2015.00017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 04/27/2015] [Indexed: 12/03/2022] Open
Affiliation(s)
- Shigeki Matsubara
- Department of Obstetrics and Gynecology, Jichi Medical University , Tochigi , Japan
| | - Hironori Takahashi
- Department of Obstetrics and Gynecology, Jichi Medical University , Tochigi , Japan
| | - Alan K Lefor
- Department of Surgery, Jichi Medical University , Tochigi , Japan
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Matsubara S. Re: removable uterine compression sutures for postpartum haemorrhage. BJOG 2015; 122:755-6. [PMID: 25800389 DOI: 10.1111/1471-0528.13190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2014] [Indexed: 11/27/2022]
Affiliation(s)
- S Matsubara
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Japan
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