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Cordeiro Féria B, Nazaré P, Figueiredo J, Neves Gomes I, Pereira A. Efficacy, Complications and Effects of Alcides Pereira's Sutures in the Management of Uterine Atony: A Retrospective Study. ACTA MEDICA PORT 2024. [PMID: 38447018 DOI: 10.20344/amp.20429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 11/08/2023] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Uterine compressive sutures are conservative measures applied in cases of severe postpartum hemorrhage unresponsive to uterotonics. Pereira's suture was introduced in 2005 and consists of two longitudinal and three transverse non-transfixes sutures. Previous studies reported favorable results, highlighting its benefits and value. The aim of this study was to assess the efficacy, complications, and impact on fertility and future pregnancies of Pereira's suture applied in cases of uterine atony and postpartum hemorrhage. METHODS An observational retrospective study was performed by consulting the medical records of women treated with Pereira's compressive sutures in a tertiary center between January 2013 and December 2022. We registered demographic data, pregnancy outcomes, short-term complications, and outcomes of subsequent pregnancies. RESULTS A total of 50 women were treated with Pereira's suture. The overall success rate was 96% and no hysterectomies were performed. Women who had sutures performed during an intra-cesarean section had better outcomes than those who had an after-cesarean section. Complications were reported in 12% (n = 6) of women, with the most frequent being pelvic infection (n = 3) and abdominal pain (n = 3). Regarding fertility, all women desiring a future pregnancy (n = 5) were able to conceive, resulting in three live births. CONCLUSION Pereira's suture is a type of suture that provides numerous advantages and should be considered when first-line medical treatment fails. When applied at an early stage, the sutures may prevent maternal morbidity. The Alcides Pereira's suture is a safe technique and appears to preserve fertility.
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Affiliation(s)
| | - Patrícia Nazaré
- Serviço de Ginecologia e Obstetrícia. Hospital Garcia de Orta. Almada. Portugal
| | - Joana Figueiredo
- Serviço de Ginecologia e Obstetrícia. Hospital Garcia de Orta. Almada. Portugal
| | - Inês Neves Gomes
- Serviço de Ginecologia e Obstetrícia. Hospital Garcia de Orta. Almada. Portugal
| | - Alcides Pereira
- Serviço de Ginecologia e Obstetrícia. Hospital Garcia de Orta. Almada. Portugal
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2
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García-Guerra R, Assaf-Balut M, El-Bakkali S, de Ávila-Benavides IP, Huertas-Fernández MÁ. Uterine necrosis following hemostatic compression suture: case report and review of the literature. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGIA 2022; 73:378-387. [PMID: 36637386 PMCID: PMC9856609 DOI: 10.18597/rcog.3856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/10/2022] [Indexed: 12/30/2022]
Abstract
Objectives To present a case of uterine necrosis following hemostatic suturing to control postpartum bleeding, and to review the literature in order to identify the suture techniques employed, clinical findings, diagnostics and treatment in the clinical cases described. Material and methods A 34-year-old woman presenting with abdominal pain eight days after cesarean delivery due to placenta previa who required B-Lynch compression suture due to uterine atony, and who was diagnosed with uterine necrosis. The patient underwent total abdominal hysterectomy with a satisfactory recovery. A systematic literature search was conducted in the Medline vía Pubmed, Embase and Web of Science databases. The search included case series and reports, and cohorts of women with uterine necrosis following the use of uterine compression sutures for postpartum bleeding. The analysis included sociodemographic and clinical variables at the time of diagnosis, suturing technique, diagnostic tests and treatment. Results Overall, 23 studies with 24 patients were included. Of all necrosis cases, 83% occurred following cesarean section. B-Lynch was the suturing technique most frequently used (66 %), followed by the Cho suture (25 %). The most frequent symptoms were fever and abdominal pain. The most commonly used diagnostic test was computed tomography (9/24 cases). Hysterectomy was performed in the majority of cases (75 %). Conclusions Although rare, uterine wall necrosis is a serious complication. It would be advisable to design follow-up cohort studies of women undergoing these procedures in order to determine the incidence of associated complications.
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Affiliation(s)
- Raquel García-Guerra
- Especialista en Ginecología y Obstetricia, Hospital Universitario de Getafe, Madrid (España).Hospital Universitario de GetafeMadridEspaña, Correspondencia: Raquel García-Guerra. Hospital Universitario de Getafe, Carr. Madrid-Toledo, km 12,500, 28905, Getafe, Madrid (España). Correo electrónico:
| | - Myrna Assaf-Balut
- Residente de Ginecología y Obstetricia, Hospital Universitario de Getafe, Madrid (España).Hospital Universitario de GetafeMadridEspaña
| | - Sara El-Bakkali
- Especialista en Ginecología y Obstetricia, Hospital Universitario Ibn Sina, Rabat (Marruecos).Hospital Universitario Ibn SinaRabatMarruecos
| | - Irene Pérez de Ávila-Benavides
- Jefa de sección de Ginecología y Obstetricia, Hospital Universitario de Getafe, Madrid (España).Hospital Universitario de GetafeMadridEspaña
| | - Miguel Ángel Huertas-Fernández
- Jefe de servicio de Ginecología y Obstetricia, Hospital Universitario de Getafe, Madrid (España).Hospital Universitario de GetafeMadridEspaña
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3
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Escobar MF, Nassar AH, Theron G, Barnea ER, Nicholson W, Ramasauskaite D, Lloyd I, Chandraharan E, Miller S, Burke T, Ossanan G, Andres Carvajal J, Ramos I, Hincapie MA, Loaiza S, Nasner D. FIGO recommendations on the management of postpartum hemorrhage 2022. Int J Gynaecol Obstet 2022; 157 Suppl 1:3-50. [PMID: 35297039 PMCID: PMC9313855 DOI: 10.1002/ijgo.14116] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Maria Fernanda Escobar
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Anwar H Nassar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Gerhard Theron
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.,Tygerberg Hospital, Cape Town, South Africa
| | - Eythan R Barnea
- Society for Investigation or Early Pregnancy (SIEP), New York, New York, USA
| | - Wanda Nicholson
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Diana Ramasauskaite
- Center of Obstetrics and Gynecology, Vilnius University Medical Faculty, Vilnius, Lithuania
| | - Isabel Lloyd
- Department of Obstetrics and Gynecology, Universidad de Panamá, Panama City, Panamá.,Hospital Santo Tomas, Panama City, Panamá
| | - Edwin Chandraharan
- Department of Obstetrics and Gynecology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Suellen Miller
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Thomas Burke
- Division of Global Health and Human Rights, Massachusetts General Hospital, Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Harvard T.H. Chan School of Public Health, Boston, USA
| | - Gabriel Ossanan
- Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Javier Andres Carvajal
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Isabella Ramos
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Maria Antonia Hincapie
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Sara Loaiza
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Daniela Nasner
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
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- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia
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4
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Luo L, Wan J, Chen X, Zhang H, Zhang M, Chen Q. Uterine necrosis, infection, and subinvolution: complications observed after combined application of modified B-Lynch suture and vascular ligation. J Int Med Res 2021; 49:3000605211010730. [PMID: 33947256 PMCID: PMC8113939 DOI: 10.1177/03000605211010730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Compression sutures are primarily used to treat atonic postpartum hemorrhage. We
herein describe three cases of selective arterial ligation combined with B-Lynch
or modified B-Lynch suture for the treatment of intractable postpartum
hemorrhage unresponsive to available conservative interventions. Three pregnant
women underwent a cesarean section for a macrosomic fetus, fetal distress, and
oligohydramnios, respectively. All three women developed intractable postpartum
hemorrhage due to uterine atony with no chance of embolization therapy. B-Lynch
or modified B-Lynch suture and additional selective arterial ligation were
performed using braided absorbable suture. The first woman developed
postoperative hematometra and infection without response to drainage and
antibiotic therapy. Although laparoscopic exploration was performed to loosen
the suture line and drain the hematometra and pyometra, the necrosis and
infection could not be controlled. Subtotal hysterectomy was therefore
conducted, and the necrotic uterine adnexa was removed. The other two women
developed subinvolution of the uterus resulting in prolonged menstruation and
amenorrhea, although the uterus was preserved and the bleeding was controlled.
Modified B-Lynch suture combined with vascular ligation is an invaluable
technique for women with severe intractable postpartum hemorrhage. However, it
can lead to serious complications such as uterine necrosis, infection, and
subinvolution.
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Affiliation(s)
- Linfeng Luo
- The First Clinical Medical College of Nanchang University, Nanchang, Jiangxi, China
| | - Junhui Wan
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xinping Chen
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Huan Zhang
- Department of Gynaecology and Obstetrics, Jinxian County People's Hospital, Nanchang, Jiangxi, China
| | - Minjie Zhang
- Queen Mary College of Nanchang University, Nanchang, Jiangxi, China
| | - Qi Chen
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Theron GB, Mpumlwana V. A case series of post-partum haemorrhage managed using Ellavi uterine balloon tamponade in a rural regional hospital. S Afr Fam Pract (2004) 2021; 63:e1-e4. [PMID: 34082561 PMCID: PMC8377784 DOI: 10.4102/safp.v63i1.5266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/05/2021] [Accepted: 03/07/2021] [Indexed: 11/17/2022] Open
Abstract
Uterine balloon tamponade (UBT) should be attempted once emergency measures have been applied and medical treatment for post-partum haemorrhage (PPH) resulting from an atonic uterus has failed. Sinapi Biomedical (Pty) Ltd developed the Ellavi UBT, a free-flow pressure-controlled UBT unit. The device is affordable for use in lesser-resourced countries. A case series of Ellavi UBT used by medical officers in a rural regional hospital without specialist supervision was conducted. This case series was conducted in St Elizabeth’s Hospital in Lusikisiki, South Africa. The hospital serves as the regional hospital for the Ingquza Hill Subdistrict in the Eastern Cape Province. The Nelson Mandela Academic Hospital (NMAH) in Mthatha is the tertiary referral hospital. Workshops were conducted on the use of Ellavi UBT, and devices were made freely available to the hospital. The case series included 10 patients. Six patients delivered by caesarean section, and four had normal vertex deliveries. All patients had additional oxytocin infusions, and eight patients received misoprostol. Following the insertion and inflation of the Ellavi UBT, the PPH stopped in seven patients, was much reduced in one patient and reduced in one patient. In one case, the Ellavi UBT had no effect on the bleeding. All 10 patients were referred to the NMAH. All patients in the case series had good outcomes. The insertion of the Ellavi UBT and subsequent referral proved to be feasible in a rural regional hospital. All patients included in the case series arrived at the referral hospital and had a good outcome.
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Affiliation(s)
- Gerhard B Theron
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town.
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6
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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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7
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Agrawal S, Aggarwal K, Chaudhary V, Satija B, Rajagopalan I, Sethi A. Ischemic uterine necrosis following Hayman suture for postpartum hemorrhage. Int J Gynaecol Obstet 2020; 152:277-279. [PMID: 32783188 DOI: 10.1002/ijgo.13343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/23/2020] [Accepted: 08/10/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Swati Agrawal
- Lady Hardinge Medical College & Smt. Sucheta Kriplani Hospital, New Delhi, India
| | - Kiran Aggarwal
- Lady Hardinge Medical College & Smt. Sucheta Kriplani Hospital, New Delhi, India
| | - Vidhi Chaudhary
- Lady Hardinge Medical College & Smt. Sucheta Kriplani Hospital, New Delhi, India
| | - Bhawna Satija
- Lady Hardinge Medical College & Smt. Sucheta Kriplani Hospital, New Delhi, India
| | - Induja Rajagopalan
- Lady Hardinge Medical College & Smt. Sucheta Kriplani Hospital, New Delhi, India
| | - Alisha Sethi
- Lady Hardinge Medical College & Smt. Sucheta Kriplani Hospital, New Delhi, India
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8
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Kwong LT, So PL, Wong SF. Uterine compression sutures with additional hemostatic procedures for the management of postpartum hemorrhage. J Obstet Gynaecol Res 2020; 46:2332-2339. [PMID: 32815234 DOI: 10.1111/jog.14426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/02/2020] [Accepted: 07/26/2020] [Indexed: 11/26/2022]
Abstract
AIM The aim of the study was to evaluate the efficacies and possible short-term complications in women receiving uterine compression sutures only and those with additional hemostatic procedures for the management of postpartum hemorrhage. METHODS It was a retrospective study carried out from year 2009 to 2019 at a tertiary obstetric hospital and included 79 women who underwent uterine compression sutures (B-Lynch sutures, Hayman's sutures and Cho's sutures) for primary postpartum hemorrhage. Thirty-six of these women had additional hemostatic procedures (uterine artery ligation or embolization) performed for bleeding control. RESULTS Of the 43 women who were primarily treated with uterine compression sutures only, the success rate to preserve the uterus was 97.7% (42/43). In women with uterine compression sutures and additional hemostatic procedures performed, the success rate was 75% (27/36). Among these two groups of women without peripartum hysterectomy, there were no significant differences in the incidence of secondary postpartum hemorrhage (14.8% vs. 11.9%; P = 0.729), postoperative endometritis (14.8% vs. 14.3%; P > 0.99) and retained products of conception (3.7% vs. 9.5%; P = 0.641) during their 6-week postpartum checkup. Three women were diagnosed to have hematometra. No pyometra or uterine necrosis was noted. CONCLUSION Uterine compression sutures with additional hemostatic procedures are effective to control postpartum hemorrhage and prevent hysterectomy. The short-term complication rate is low. Long-term monitoring is needed to identify rare but potentially dangerous complications.
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Affiliation(s)
- Lee Ting Kwong
- 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
| | - Sai Fun Wong
- Department of Obstetrics and Gynecology, Tuen Mun Hospital, Tuen Mun, Hong Kong
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9
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Pavlović M, Zudenigo D, Kerner M, Mikuš M, Matak L. The management of unusual uterine rupture: new aspects. J OBSTET GYNAECOL 2020; 41:824-825. [PMID: 32720529 DOI: 10.1080/01443615.2020.1786029] [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]
Affiliation(s)
- Milan Pavlović
- Department of Gynecology and Obstetrics, Clinical Hospital Sveti Duh, Zagreb, Croatia
| | - Damir Zudenigo
- Department of Gynecology and Obstetrics, Clinical Hospital Sveti Duh, Zagreb, Croatia
| | - Mario Kerner
- Department of Gynecology and Obstetrics, Clinical Hospital Sveti Duh, Zagreb, Croatia
| | - Mislav Mikuš
- Department of Gynecology and Obstetrics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Luka Matak
- Department of Gynecology and Obstetrics, General Hospital Zadar, Zadar, Croatia
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A Rare Case of Watery Vaginal Discharge due to Caesarean Scar Dehiscence following Brace Suture and Balloon Tamponade for the Management of Postpartum Hemorrhage. Case Rep Obstet Gynecol 2020; 2020:2064782. [PMID: 32181033 PMCID: PMC7063215 DOI: 10.1155/2020/2064782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/14/2020] [Indexed: 11/18/2022] Open
Abstract
A woman in her early twenties with dichorionic diamniotic twins underwent emergency caesarean section (CS) for failed induction of labor for discordant growth at 37 weeks. Her CS was complicated by atonic postpartum hemorrhage (PPH) requiring uterotonics, B-lynch suture, and Bakri balloon. She presented on the 5th postoperative day (POD) with fever and wound pain and collapsed due to desaturation. Investigations confirmed ascites on computed tomography (CT) of her abdomen and cardiomyopathy on echocardiogram. She was readmitted on the 22nd POD with watery vaginal discharge. CT abdomen revealed a dehisced CS scar and loculated ascites. Her discharge settled after three weeks with antibiotics and drainage of the ascites. A CT scan 3 months later showed reduction of the peritoneal collection. Caesarean scar dehiscence should be considered for patients presenting with ascites and vaginal discharge after a CS, particularly in the presence of risk factors such as infection or anemia.
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11
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Li G, Xu H, Li G. Prophylactic uterine compression sutures for addressing potential postpartum hemorrhage. J Obstet Gynaecol Res 2019; 46:547-549. [PMID: 31880366 DOI: 10.1111/jog.14187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/07/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Guang‐Tai Li
- Department of Obstetrics and GynecologyHebei Yanda Hospital, Affiliated Hebei Medical University, Yanda International Health City, Sipulan Road, Yanjiao Economic and Technological Development Zone Sanhe Hebei Province China
- Department of Obstetrics and GynecologyChina Meitan General Hospital/Emergency General Hospital Beijing China
| | - Hong‐Mei Xu
- Department of Obstetrics and GynecologyBeijing Fengtai Hospital, Affiliated Capital Medical University Beijing China
| | - Guang‐Rui Li
- Wangjing HospitalChina Academy of Chinese Medical Sciences Beijing China
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12
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Ryu JM, Choi YS, Bae JY. Bleeding control using intrauterine continuous running suture during cesarean section in pregnant women with placenta previa. Arch Gynecol Obstet 2018; 299:135-139. [PMID: 30386992 DOI: 10.1007/s00404-018-4957-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 10/25/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the effectiveness of intrauterine continuous running suture during cesarean section in pregnant women with placenta previa. METHODS We enrolled 277 women and medical records were retrospectively reviewed. Pregnant women were grouped according to uterine bleeding control methods as follows: Group A, using intrauterine continuous running suture and Group B (control group) using figure-of-eight suture. RESULTS Intrauterine continuous running sutures were used in 104 pregnant women. Mean total blood loss in Group A was significantly less than that in Group B (1332.70 ± 152.92 mL vs 1861.56 ± 157.74 mL, P = 0.029). Mean total transfusion unit of Group A was significantly less than that in Group B (1.74 ± 0.41 vs 3.52 ± 0.75, P = 0.037). CONCLUSIONS Intrauterine continuous running sutures can significantly reduce postpartum blood loss and transfusion units during cesarean section in pregnant women with placenta previa.
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Affiliation(s)
- Jung Min Ryu
- Department of Obstetrics and Gynecology, School of Medicine, Catholic University of Daegu, Gyeongsan, South Korea
| | - Yoon Seok Choi
- Department of Obstetrics and Gynecology, School of Medicine, Catholic University of Daegu, Gyeongsan, South Korea
| | - Jin Young Bae
- Department of Obstetrics and Gynecology, School of Medicine, Catholic University of Daegu, Gyeongsan, South Korea.
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13
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Songthamwat S, Songthamwat M. Uterine flexion suture: modified B-Lynch uterine compression suture for the treatment of uterine atony during cesarean section. Int J Womens Health 2018; 10:487-492. [PMID: 30197543 PMCID: PMC6113941 DOI: 10.2147/ijwh.s170460] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of this study was to report our clinical experience of applying a uterine flexion suture, which was modified from the B-Lynch uterine compression suture, for treating uterine atony during cesarean section. Materials and methods This is a retrospective descriptive study describing the use of a new technique, uterine flexion suture, for treating uterine atony during cesarean section. The study period was from January 2009 to December 2017 at Udonthani Hospital, Udonthani, Thailand. Uterine atony during cesarean section was treated by manual compression, intravenous oxytocin, methylergonovine maleate, and prostaglandins and then was observed for 10-15 minutes before applying a uterine flexion suture in the failed medical treatment cases. The patients were observed for vaginal bleeding, hematometra, and infection after operation. Uterine ultrasound scan results on days 1, 7, and 30 postoperation were also reviewed. Results Fifty-seven patients with uterine atony during cesarean delivery received the uterine flexion suture. The mean age of patients was 27.0 (15-44 years). Thirty-four patients were primipara. The indications for cesarean section were cephalopelvic disproportion in 27 (47.4%) cases, and previous cesarean section in 11 (19.3%) cases. Neither postoperative excessive bleeding nor hysterectomy was observed. There was no hematometra or serious postoperative complication after surgery. The estimated time for uterine flexion suture is only 2-3 minutes and was very easy to perform. Conclusion Uterine flexion suture technique, which was modified from the B-Lynch suture, was inexpensive, quick, and effective in the treatment of atonic postpartum uterus in women undergoing cesarean section.
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Affiliation(s)
- Srisuda Songthamwat
- Department of Obstetrics and Gynecology, Udonthani Hospital, Udonthani, Thailand,
| | - Metha Songthamwat
- Department of Obstetrics and Gynecology, Udonthani Hospital, Udonthani, Thailand,
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14
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Thakur M, Rathore SS, Jindal A, Mahajan K. Uterocutaneous fistula following B-Lynch suture for primary postpartum haemorrhage. BMJ Case Rep 2018; 2018:bcr-2017-223518. [PMID: 29305372 DOI: 10.1136/bcr-2017-223518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 30-year-old woman, who had undergone emergency lower segment caesarean section (LSCS) for failed induction 2 months back, presented with a fistulous opening along with discharge from her previous incision scar. She had developed a massive primary postpartum haemorrhage at the time of LSCS 2 months back, which was managed with B-Lynch suture and vessel ligation. Fistulogram revealed a connection between the uterus and the skin. The diagnosis was confirmed by a contrast-enhanced CT scan. Patient was subjected to laparotomy. She was found to have an extensive necrosis of the anterior uterine wall. Total abdominal hysterectomy was done to avoid the risk of sepsis and haemorrhage. Postoperative period was uneventful. Histopathological examination confirmed the necrosis of the uterine wall. This case describes an extremely rare occurrence of uterocutaneous fistula as a result of uterine infarction following the application of B-Lynch suture for primary postpartum haemorrhage.
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Affiliation(s)
- Monika Thakur
- Department of Obstetrics and Gynaecology, Indira Gandhi Medical College, Shimla, India
| | - Sandeep S Rathore
- Department of Obstetrics and Gynaecology, Indira Gandhi Medical College, Shimla, India
| | - Aditi Jindal
- Department of Obstetrics and Gynaecology, Indira Gandhi Medical College, Shimla, India
| | - Kunal Mahajan
- Department of Interventional Cardiology, Holy Heart Advanced Cardiac Care and Research Centre, Rohtak, India
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15
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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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16
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Suzuki Y, Matsuzaki S, Mimura K, Kumasawa K, Tomimatsu T, Endo M, Kimura T. Investigation of perioperative complications associated with use of uterine compression sutures. Int J Gynaecol Obstet 2017; 139:28-33. [DOI: 10.1002/ijgo.12249] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/28/2017] [Accepted: 06/26/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Yosuke Suzuki
- Department of Obstetrics and Gynecology; Osaka University Graduate School of Medicine; Osaka Japan
| | - Shinya Matsuzaki
- Department of Obstetrics and Gynecology; Osaka University Graduate School of Medicine; Osaka Japan
| | - Kazuya Mimura
- Department of Obstetrics and Gynecology; Osaka University Graduate School of Medicine; Osaka Japan
| | - Keiichi Kumasawa
- Department of Obstetrics and Gynecology; Osaka University Graduate School of Medicine; Osaka Japan
| | - Takuji Tomimatsu
- Department of Obstetrics and Gynecology; Osaka University Graduate School of Medicine; Osaka Japan
| | - Masayuki Endo
- Department of Obstetrics and Gynecology; Osaka University Graduate School of Medicine; Osaka Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology; Osaka University Graduate School of Medicine; Osaka Japan
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17
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Dohbit JS, Foumane P, Nkwabong E, Kamouko CO, Tochie JN, Otabela B, Mboudou E. Uterus preserving surgery versus hysterectomy in the treatment of refractory postpartum haemorrhage in two tertiary maternity units in Cameroon: a cohort analysis of perioperative outcomes. BMC Pregnancy Childbirth 2017; 17:158. [PMID: 28558661 PMCID: PMC5450395 DOI: 10.1186/s12884-017-1346-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 05/24/2017] [Indexed: 11/21/2022] Open
Abstract
Background Little evidence exists on the efficacy and safety of the different surgical techniques used in the treatment of postpartum haemorrhage (PPH). We aimed to compare uterus preserving surgery (UPS) versus hysterectomy for refractory PPH in terms of perioperative outcomes in a sub-Saharan African country with a known high maternal mortality ratio due to PPH. Methods This was a retrospective cohort study comparing the perioperative outcomes of all women managed by UPS (defined as surgical interventions geared at achieving haemostasis while conserving the uterus) versus hysterectomy (defined as surgical resection of the uterus to achieve haemostasis) for PPH refractory to standard medical management in two tertiary hospitals in Cameroon from January 2004 to December 2014. We excluded patients who underwent hysterectomy after failure of UPS. Comparison was done using the Chi-square test or Fisher exact test where appropriate. Bonferroni adjustment of the p-value was performed in order to reduce the chance of obtaining false-positive results. Results We included 24 cases of UPS against 36 cases of hysterectomy. The indications of surgery were dominated by uterine rupture and uterine atony in both groups. Types of UPS performed were seven bilateral hypogastric artery ligations, seven hysterorraphies, six bilateral uterine artery ligations, three B-Lynch sutures and one Tsirulnikov triple ligation with an overall uterine salvage rate of 83.3%. Types of hysterectomies were 26 subtotal hysterectomies and 10 total hysterectomies. UPS was associated with maternal deaths (RR: 2.3; 95% CI: 1.38–3.93.; p: 0.0015) and postoperative infections (RR: 1.96; 95% CI: 1.1–3.49; p: 0.0215). The association of UPS with maternal death was not attenuated after Bonferroni correction. Hysterectomy had no statistically significant adverse outcome. Conclusion Hysterectomy is safer than UPS in the management of intractable PPH in our setting. The choice of UPS as first-line surgical management of PPH in resource-limited settings should entail diligent anticipation of these adverse maternal outcomes in order to lessen the perioperative burden of PPH.
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Affiliation(s)
- Julius Sama Dohbit
- Department of Obstetrics and Gynaecology, Gynaeco-Obstetric and Paediatric Hospital, Yaounde, Cameroon.,Department of Obstetrics and Gynaecology, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Pascal Foumane
- Department of Obstetrics and Gynaecology, Gynaeco-Obstetric and Paediatric Hospital, Yaounde, Cameroon.,Department of Obstetrics and Gynaecology, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Elie Nkwabong
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.,Department of Obstetrics and Gynaecology, University Hospital Centre, Yaounde, Cameroon
| | - Christelle Ogolong Kamouko
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Joel Noutakdie Tochie
- Department of Surgery and sub-Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon. .,Health and Human development (2HD) Research Group, Douala, Littoral Region, Cameroon.
| | | | - Emile Mboudou
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.,Department of Obstetrics and Gynaecology, Gynaeco-Obstetric and Paediatric Hospital, Douala, Cameroon
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18
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Successful term delivery after Khairy’s modified B-lynch suture technique: First case report. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2017. [DOI: 10.1016/j.mefs.2016.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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19
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Rani PR, Begum J. Recent Advances in the Management of Major Postpartum Haemorrhage - A Review. J Clin Diagn Res 2017; 11:QE01-QE05. [PMID: 28384942 DOI: 10.7860/jcdr/2017/22659.9463] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 10/25/2016] [Indexed: 11/24/2022]
Abstract
Postpartum haemorrhage (PPH) is a leading cause of maternal mortality and morbidity worldwide and 75-90% of these haemorrhage results from uterine atony. Delayed and substandard obstetrics care can kill a woman within hours of Major Obstetric Haemorrhage (MOH). Prenatal identification of at risk women, prompt assessment of blood loss, effective management and involvement of multidisciplinary teams is of utmost importance to save the lives of these women. However, even with the best prenatal care, PPH occurs, it can occur without any risk factors. The first step in management is achieving haemodynamic stability, second being arrest of bleeding, both are done simultaneously. Cases of refractory PPH is managed by postpartum hysterectomy which results in complete inability in hosting a future pregnancy, a psychological impact and risk of intra operative surgical morbidities. This review discusses the current evidence based management of PPH, existing controversies in transfusion of blood and blood products and newer advances in this field. It was conducted by searching the English language medical literature using Medline (1994-2015). The current scenario in developing countries mandates research on newer and practicable strategies to tackle PPH which can be implemented effectively and have an upper edge over the existing practices in the management of PPH.
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Affiliation(s)
- P Reddi Rani
- Professor, Department of Obstetrics and Gynaecology, Mahatama Gandhi Medical College and Research , Pillaiyarkuppam, Puducherry, India
| | - Jasmina Begum
- Associate Professor, Department of Obstetrics and Gynaecology, Mahatama Gandhi Medical College and Research , Pillaiyarkuppam, Puducherry, India
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20
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Indiran V, Kannan K, Maduraimuthu P. CT and MR imaging of uterine necrosis following B-Lynch and Hayman suturing for postpartum hemorrhage. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2016. [DOI: 10.1016/j.injms.2016.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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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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22
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Which uterine sparing technique should be used for uterine atony during cesarean section? The Bakri balloon or the B-Lynch suture? Arch Gynecol Obstet 2016; 294:511-7. [DOI: 10.1007/s00404-016-4015-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 01/05/2016] [Indexed: 10/22/2022]
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23
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[Obstetric outcomes after uterine compression suture for treatment of postpartum hemorrhage: Long-term monitoring of 40 cases]. ACTA ACUST UNITED AC 2015; 43:509-14. [PMID: 26144065 DOI: 10.1016/j.gyobfe.2015.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 06/03/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Uterine atony is the first cause of postpartum hemorrhage. In caesarean section, different techniques of uterine compression suture exist when uterotonic drugs fail. Their effectiveness is shown but little data on their effects on subsequent pregnancies are available. The aim of this work is analyze of the obstetrical long-term consequences after uterine compression suture. PATIENTS AND METHODS This is a retrospective study of 40 cases of uterine compression suture performed in a level III maternity, between 2004 and 2010. The main objective is the evaluation of the obstetrical prognosis of subsequent pregnancies. The efficacy and safety of surgical techniques, according to their transfixing character or not, were analyzed. RESULTS Eleven pregnancies after uterine compression suture were reported among 14 women whishing another pregnancy. The median time to be pregnant was 27 months (6-78 months). Nine pregnancies were conducted at term. One case of intrauterine growth restriction and a moderate prematurity at 32 weeks were observed. There was no significant difference in efficacy and early surgical complications according to the surgical technique; however, both infectious and ischemic complications were observed after transfixing compression suture. CONCLUSION The obstetric prognosis after a uterine compression suture is kept. The transfixing techniques may cause more infectious and ischemic complications. An evaluation of surgical techniques depending on their transfixing, or not, character on a large cohort is necessary for the evaluation of the influence of the technique on fertility and postoperative complications.
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24
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Tadakawa M, Sugawara J, Saito M, Nishigori H, Utsunomiya H, Nagase S, Tokunaga H, Kurakata-Nakamura M, Sugiyama T, Yaegashi N. Fertility and pregnancy outcomes following B-Lynch sutures for post-partum hemorrhage. J Obstet Gynaecol Res 2014; 41:559-64. [PMID: 25331482 DOI: 10.1111/jog.12590] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 08/10/2014] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to investigate the long-term fertility prognosis after B-Lynch sutures for post-partum hemorrhage (PPH). METHODS A retrospective observational study was conducted on patients who underwent B-Lynch sutures in our hospital between 2005 and 2010. Patient data was collected from hospital records. Information regarding subsequent pregnancies and menstrual complications were obtained by posted questionnaires and telephone interviews with patients who avoided hysterectomy. RESULTS A total of 28 B-Lynch sutures were performed in 3976 deliveries, all in patients that underwent cesarean section. Twenty-two of the 26 patients who avoided hysterectomy answered our questionnaire or took part in an interview. All patients recovered regular menstruation with no severe complications. Of the 19 patients who wanted another child, 12 patients (63.2%) had 14 subsequent pregnancies in a mean follow-up period of 52.1 months. The results of pregnancies were nine uncomplicated term pregnancies, all delivered by elective cesarean section, two artificial abortions and three miscarriages. A significant difference was observed in the age of patients with subsequent pregnancies and those without pregnancies (30.8 vs 34.6 years, P = 0.04). CONCLUSION B-Lynch sutures for PPH do not appear to jeopardize fecundity. An older age was a risk factor for achieving subsequent pregnancies.
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Affiliation(s)
- Mari Tadakawa
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
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25
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B-Lynch uterine compression sutures in the conservative surgical management of uterine atony. Arch Gynecol Obstet 2014; 291:1005-14. [PMID: 25315382 DOI: 10.1007/s00404-014-3511-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 10/07/2014] [Indexed: 10/24/2022]
Abstract
AIM To evaluate the success rate and possible complications of the B-Lynch uterine compression sutures in women who suffered from postpartum uterine atony unresponsive to medical treatment. MATERIALS AND METHODS A total of 36 women who were managed with the B-Lynch suture, with or without additional surgical procedures following uterine atony unresponsive to medical treatment, were evaluated retrospectively. RESULTS Sixteen women were primarily managed with the B-Lynch compression sutures, and 11 women had the B-Lynch compression sutures following failure of achievement of hemostasis by ligation of uterine artery alone (n = 4), or uterine artery plus uterine branch of ovarian artery (n = 7). Eight women had bilateral internal iliac artery ligation (BIIAL) following failure of achievement of hemostasis by the B-Lynch compression sutures. Two women (5.5%) underwent post-cesarean hysterectomy. The overall success rate of B-Lynch was 75% (27/36), and the overall success rate of B-Lynch plus BIIAL was 94.4% (34/36). Three women were admitted to the intensive care unit. There was no death related to the hemorrhage in our series. No short-term complications such as uterine necrosis, hematometra, pyometra, or uterine erosion related to the uterine compression suture were observed. CONCLUSION Overall success rate of the B-Lynch sutures and B-Lynch sutures plus BIIAL was 75 and 94.4%, respectively. The B-Lynch technique does not necessarily require specific suture material. Uterine devascularization or BIIAL did not increase the risk of the possible short-term complications such as uterine necrosis. In case of failure of the B-Lynch uterine compression sutures, BIIAL may be beneficial to save the uterus.
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26
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Zhang ZW, Liu CY, Yu N, Guo W. Removable uterine compression sutures for postpartum haemorrhage. BJOG 2014; 122:429-33. [PMID: 25175111 DOI: 10.1111/1471-0528.13025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2014] [Indexed: 11/30/2022]
Affiliation(s)
- ZW Zhang
- Department of Obstetrics; Shandong Provincial Qianfoshan Hospital; Shandong University; Jinan China
| | - CY Liu
- Department of Obstetrics; Jinan Maternity and Child Care Hospital; Jinan China
| | - N Yu
- Department of Obstetrics; Shandong Provincial Qianfoshan Hospital; Shandong University; Jinan China
| | - W Guo
- Department of Obstetrics; Shandong Provincial Qianfoshan Hospital; Shandong University; Jinan China
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27
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Begum J, Pallave P, Ghose S. B-lynch: a technique for uterine conservation or deformation? A case report with literature review. J Clin Diagn Res 2014; 8:OD01-3. [PMID: 24959485 DOI: 10.7860/jcdr/2014/8139.4284] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 01/31/2014] [Indexed: 11/24/2022]
Abstract
Postpartum haemorrhage is a leading cause of global maternal mortality and morbidity, accounting for 25-30% of all maternal deaths, and 75-90% of these casualties result from uterine atony. Uterine compressive sutures are a well established measure for control of haemorrhage following atonic postpartum haemorrhage, when medical and nonmedical interventions fail. Here, we are reporting a case of secondary infertility in a 24-year-old lady who had undergone an elective caesarean section for central placenta previa in her first pregnancy. She had massive postpartum haemorrhage, for which B-Lynch suture and vessel ligation were done. Subsequently, she failed to conceive for 4 years. This was because of severe pelvic adhesions and uterine deformation which were found intraoperatively, as a consequence of previous use of B-Lynch suture. As no definitive treatment could be offered to her, we suggested her to go for adoption.
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Affiliation(s)
- Jasmina Begum
- Assistant Professor, Department of Obstetrics and Gynaecology, Mahatama Gandhi Medical College and Research Institute , Puducherry, India
| | - P Pallave
- Associate Professor, Department of Obstetrics and Gynaecology, Mahatama Gandhi Medical College and Research Institute , Puducherry, India
| | - Seetesh Ghose
- Professor, Department of Obstetrics and Gynaecology, Mahatama Gandhi Medical College and Research Institute , Puducherry, India
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28
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Kato S, Tanabe A, Kanki K, Suzuki Y, Sano T, Tanaka K, Fujita D, Terai Y, Kamegai H, Ohmichi M. Local injection of vasopressin reduces the blood loss during cesarean section in placenta previa. J Obstet Gynaecol Res 2014; 40:1249-56. [DOI: 10.1111/jog.12356] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 11/12/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Sosuke Kato
- Department of Obstetrics and Gynecology; Osaka Medical College; Osaka Japan
| | - Akiko Tanabe
- Department of Obstetrics and Gynecology; Osaka Medical College; Osaka Japan
| | - Kazuyoshi Kanki
- Department of Obstetrics and Gynecology; Osaka Medical College; Osaka Japan
| | - Yusuke Suzuki
- Department of Obstetrics and Gynecology; Osaka Medical College; Osaka Japan
| | - Takumi Sano
- Department of Obstetrics and Gynecology; Osaka Medical College; Osaka Japan
| | - Kentaro Tanaka
- Department of Obstetrics and Gynecology; Osaka Medical College; Osaka Japan
| | - Daisuke Fujita
- Department of Obstetrics and Gynecology; Osaka Medical College; Osaka Japan
| | - Yoshito Terai
- Department of Obstetrics and Gynecology; Osaka Medical College; Osaka Japan
| | - Hideki Kamegai
- Department of Obstetrics and Gynecology; Osaka Medical College; Osaka Japan
| | - Masahide Ohmichi
- Department of Obstetrics and Gynecology; Osaka Medical College; Osaka Japan
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29
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Liu S, Mathur M, Tagore S. Complications and pregnancy outcome following uterine compression suture for postpartum haemorrhage: a single centre experience. J OBSTET GYNAECOL 2014; 34:383-6. [PMID: 24678816 DOI: 10.3109/01443615.2014.895309] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In the treatment of postpartum haemorrhage from uterine atony, uterine compression sutures, such as the B-Lynch suture and its modifications have a role with the advantage of preservation of the uterus for fertility. There is however, a risk that apposition of the anterior and posterior walls of the uterus will impede drainage of lochia, resulting in undesirable complications. We undertook a five-year retrospective study of all women who underwent uterine compression sutures at the KK Women's and Children's Hospital, between 2008 and 2012. In total, 23 women had uterine compression sutures during the study period, of which, nineteen women managed to conserve their uterus. Our complication rate was 25%, which included persistent vaginal discharge, pyometra and endometritis. There were three conceptions, with two successful pregnancies. Our study shows uterine compression suture to be a safe and effective alternative to avoid hysterectomy with preservation of fertility at the time of major postpartum haemorrhage. The outcome of subsequent pregnancies is reassuring.
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Affiliation(s)
- S Liu
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital , Singapore
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30
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Rasheed SM, Amin MM, Abd Ellah AH, Abo Elhassan AM, El Zahry MA, Wahab HA. Reproductive performance after conservative surgical treatment of postpartum hemorrhage. Int J Gynaecol Obstet 2013; 124:248-52. [DOI: 10.1016/j.ijgo.2013.08.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 08/19/2013] [Accepted: 11/19/2013] [Indexed: 10/26/2022]
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31
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Uterine necrosis following pelvic arterial embolization for post-partum hemorrhage: review of the literature. Eur J Obstet Gynecol Reprod Biol 2013; 170:309-14. [DOI: 10.1016/j.ejogrb.2013.07.016] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 06/12/2013] [Accepted: 07/08/2013] [Indexed: 11/20/2022]
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32
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Malhotra V, Bhuria V, Nanda S, Chauhan MB. Decidual Cast Following B-Lynch Suture: The Surgeon's Nightmare. J Gynecol Surg 2013. [DOI: 10.1089/gyn.2012.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Vani Malhotra
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Vandana Bhuria
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Smiti Nanda
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Meenakshi Barsaul Chauhan
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
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Antony KM, Dildy GA. Postpartum hemorrhage: the role of the Maternal-Fetal Medicine specialist in enhancing quality and patient safety. Semin Perinatol 2013; 37:246-56. [PMID: 23916023 DOI: 10.1053/j.semperi.2013.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Postpartum hemorrhage in excess of 1000 mL affects 2.9-4.3% of deliveries in North America and the prevalence is increasing (Calvert et al., 2012(1); Callaghan et al., 2010(2)). Given the unpredictable nature of most postpartum hemorrhages, all obstetric providers must understand the initial steps in the assessment and management of this emergency. In this monograph we will review the potential role of the Maternal-Fetal Medicine (MFM) specialist in managing this acute obstetric emergency. MFMs are uniquely positioned to develop hospital protocols, advocate for investment in resources to optimize outcomes, and utilize novel educational models, such as simulation, to educate other providers on the recognition and management of this condition. MFMs can also aid in the antepartum diagnosis of abnormal placentation, which is an increasingly common risk factor for severe hemorrhage.
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Affiliation(s)
- Kathleen M Antony
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, 6651 Main St, 10th Floor, Houston, TX 77030, USA.
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Mowat A, Minuzzo L, Wilson J. A necrotic uterus after a B-Lynch Suture: fertility sparing surgery. Aust N Z J Obstet Gynaecol 2013; 53:408-9. [PMID: 23647460 DOI: 10.1111/ajo.12096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 04/01/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Alex Mowat
- Department of Obstetrics and Gynaecology, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia.
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Fawcus S, Moodley J. Postpartum haemorhage associated with caesarean section and caesarean hysterectomy. Best Pract Res Clin Obstet Gynaecol 2013; 27:233-49. [DOI: 10.1016/j.bpobgyn.2012.08.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 08/24/2012] [Indexed: 11/28/2022]
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Ali MK, Badee AYA, Abbas AM, Shazly SAEM. A novel technique for modified B-Lynch suture for the control of atonic postpartum haemorrhage. Aust N Z J Obstet Gynaecol 2013; 53:94-7. [DOI: 10.1111/ajo.12043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Accepted: 11/23/2012] [Indexed: 11/28/2022]
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Uteroumbilical fistula with myometrial necrosis following compression suture for atonic PPH: a rare case. Arch Gynecol Obstet 2012. [DOI: 10.1007/s00404-012-2606-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Vetere PF, Wayock CP, Muscat J, Sicuranza G. A novel approach to teaching placement of a B-lynch suture: description of technique and validation of teaching model. J Grad Med Educ 2012; 4:367-9. [PMID: 23997884 PMCID: PMC3444193 DOI: 10.4300/jgme-d-11-00186.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 01/23/2012] [Accepted: 02/26/2012] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Postpartum hemorrhage is a major cause of maternal morbidity and mortality throughout the world and uterine atony is the leading cause of postpartum hemorrhage. The B-Lynch brace suture is a fertility-sparing approach to treating intractable uterine atony at the time of cesarean delivery. However, many obstetricians lack confidence to perform this procedure, which they may not have performed during residency. In order to train all residents to perform the B-Lynch brace suture, we developed a realistic model by using a flank steak to imitate a gravid uterus. METHODS A convenience sample of obstetrics-gynecology faculty and residents at different levels of training at a single large hospital participated in this pilot project. Each physician reported self-perceived understanding of and confidence in performing the B-Lynch procedure before and immediately after practicing the technique using the flank-steak model, via a Likert-type survey (scale 1 = low, 5 = high). A Wilcoxon matched-pairs signed rank test was used to compare the before and after responses. RESULTS Thirty-four participants completed the flank-steak model training and pretraining/posttraining surveys. The median score (range) for self-perceived understanding was 4 (2-5) and increased to 5 (4-5) (P < .01) after exposure to the training model. The confidence scores rose from 3 (1-5) to 5 (4-5) (P < .01) after training. CONCLUSION The flank-steak model for teaching the B-Lynch suture significantly improved resident and faculty self-perceived understanding of and confidence in performing this procedure, which is otherwise rarely practiced in residency.
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Lodhi W, Golara M, Karangaokar V, Yoong W. Uterine necrosis following application of combined uterine compression suture with intrauterine balloon tamponade. J OBSTET GYNAECOL 2012; 32:30-1. [PMID: 22185530 DOI: 10.3109/01443615.2011.614972] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- W Lodhi
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UK
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Enriquez M, Maruri G, Ezeta G, Hidalgo L, Pérez-López FR, Chedraui P. The B-Lynch technique for the management of intraoperative uterine atony. J OBSTET GYNAECOL 2012; 32:338-41. [PMID: 22519476 DOI: 10.3109/01443615.2012.673035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This paper reports the experience of 150 B-Lynch suture applications for the management of uterine atony during caesarean section that did not respond to conventional therapeutical measures. Technique was considered effective if the need for hysterectomy was avoided. High-risk antenatal obstetrical conditions included: pre-eclampsia (12%), oligohydramnios (8%), polyhydramnios (4.7%). A total of 36% were primigravid, 66% had been in active labour, 4.7% received misoprostol and 26.7% used oxytocin for labour augmentation. Suture was successful in 95.3%, with only five cases requiring hysterectomy combined with uterine artery ligation and two uterine artery ligations alone to control bleeding and uterine atony ('floppiness'). Although 26.7% of cases required transfusions, no maternal deaths were reported, and overall women were discharged after a median 4-day hospital stay without further complications upon follow-up. The B-Lynch technique was an effective intraoperative measure to control uterine atony. Despite the encouraging results, long term assessment on a larger sample is needed in our clinical scenario.
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Affiliation(s)
- M Enriquez
- Enrique C. Sotomayor Obstetrics and Gynecology Hospital, Guayaquil, Ecuador
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Alouini S, Coly S, Mégier P, Lemaire B, Mesnard L, Desroches A. Multiple square sutures for postpartum hemorrhage: results and hysteroscopic assessment. Am J Obstet Gynecol 2011; 205:335.e1-6. [PMID: 21722873 DOI: 10.1016/j.ajog.2011.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Revised: 03/12/2011] [Accepted: 05/03/2011] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the efficiency and morbidity of multiple square sutures in severe postpartum hemorrhage. STUDY DESIGN A retrospective study encompassed 30 multiple square sutures that were performed for severe postpartum hemorrhage in 26,605 deliveries in a tertiary maternity center. The main outcome measures were the ability to stop hemorrhage and the assessment of the uterine cavity by hysteroscopy at 3 months. RESULTS Multiple square sutures stopped postpartum hemorrhage in 28 of 30 cases (93%). Twenty women underwent hysteroscopy after multiple square sutures. Eight women (40%) did not have intrauterine adhesions. Nine women (45%) had thin and localized intrauterine adhesions that were removed easily by the tip of the hysteroscope; 2 women had moderate intrauterine adhesions that were resected. One patient had endometritis followed by severe intrauterine adhesions. CONCLUSION Multiple square sutures are effective and safe for the control of severe postpartum hemorrhage and for uterine conservation in most cases. Although some patients had moderate or severe adhesions, a normal uterine cavity or minimal intrauterine adhesions that were removed easily were the most frequent findings at hysteroscopy. A prospective study may be helpful to compare the safety and efficiency of square and brace sutures.
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Affiliation(s)
- Souhail Alouini
- Department of Obstetrics and Gynecology, Centre Hospitalier Régional d'Orléans, Orléans, France.
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Al Riyami N, Hui D, Herer E, Nevo O. Uterine compression sutures as an effective treatment for postpartum hemorrhage: case series. AJP Rep 2011; 1:47-52. [PMID: 23705085 PMCID: PMC3653545 DOI: 10.1055/s-0031-1280570] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 01/22/2011] [Indexed: 11/17/2022] Open
Abstract
We evaluated the role of uterine compression sutures as a conservative treatment for postpartum hemorrhage (PPH) after failed medical treatment. We retrospectively reviewed the charts of all patients who delivered between 2003 and 2009 at a single tertiary care center and who underwent uterine compression sutures for PPH. Twelve women had uterine compression sutures for PPH. The mean age of the patients was 36.3 ± 5.2 years. The mean gestational age at delivery was 37.7 ± 2.0 weeks, and the average estimated blood loss was 2.1 ± 1.1 L. The mean procedure time to perform the uterine compression sutures was 9.3 ± 2.8 minutes. The success rate of compression sutures was 92% with only one failure resulting in a hysterectomy. Uterine compression sutures are an effective method for the treatment of PPH, thus avoiding hysterectomy and preserving potential fertility.
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Affiliation(s)
- Nihal Al Riyami
- Department of Obstetrics and Gynecology, Sunnybrook, Health Sciences Centre, University of Toronto, Toronto, Canada ; Division of Maternal-Fetal Medicine, Sunnybrook, Health Sciences Centre, University of Toronto, Toronto, Canada
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Higgins L, Chan KL, Tower C. Uterine rupture following previous uterine compression suture. J OBSTET GYNAECOL 2011; 31:544. [PMID: 21823864 DOI: 10.3109/01443615.2011.581315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- L Higgins
- Department of Obstetrics and Gynaecology, Maternal and Fetal Health Research Centre, St. Mary's Hospital, Manchester, UK.
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YOONG WAI, RIDOUT ALEXANDRA, MEMTSA MARIA, STAVROULIS ANDREAS, AREF-ADIB MERNOOSH, RAMSAY-MARCELLE ZEUDI, FAKOKUNDE ABIODUN. Application of uterine compression suture in association with intrauterine balloon tamponade (‘uterine sandwich’) for postpartum hemorrhage. Acta Obstet Gynecol Scand 2011; 91:147-151. [DOI: 10.1111/j.1600-0412.2011.01153.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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AMORIM-COSTA CÉLIA, MOTA RAQUEL, REBELO CLAUDIO, SILVA PEDROTIAGO. Uterine compression sutures for postpartum hemorrhage: is routine postoperative cavity evaluation needed? Acta Obstet Gynecol Scand 2011; 90:701-6. [DOI: 10.1111/j.1600-0412.2011.01137.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rathat G, Do Trinh P, Mercier G, Reyftmann L, Dechanet C, Boulot P, Giacalone PL. Synechia after uterine compression sutures. Fertil Steril 2011; 95:405-9. [DOI: 10.1016/j.fertnstert.2010.08.055] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 08/11/2010] [Accepted: 08/24/2010] [Indexed: 10/19/2022]
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Poujade O, Grossetti A, Mougel L, Ceccaldi PF, Ducarme G, Luton D. Risk of synechiae following uterine compression sutures in the management of major postpartum haemorrhage. BJOG 2010; 118:433-9. [DOI: 10.1111/j.1471-0528.2010.02817.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zheng J, Xiong X, Ma Q, Zhang X, Li M. A new uterine compression suture for postpartum haemorrhage with atony. BJOG 2010; 118:370-4. [PMID: 21176088 DOI: 10.1111/j.1471-0528.2010.02809.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Postpartum haemorrhage (PPH) is a major cause of worldwide maternal mortality and is still associated with significant morbidity. After the B-Lynch suture was reported in 1997, several different uterine compression sutures were found to be successful in controlling PPH. In this paper, we describe another simple variation of the uterine compression suture technique, which was performed without an incision in the uterine wall, without entering the uterine cavity and without suturing the anterior and posterior walls of the uterus together, so minimising the trauma to the uterus. This new uterine compression suture is an effective and safe surgical treatment for PPH caused by atony. It has the potential to apply to intractable PPH after vaginal delivery.
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Affiliation(s)
- J Zheng
- Department of Obstetrics, People's Liberation Army 174th Hospital, Xiamen, Fujian, China.
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Fotopoulou C, Dudenhausen JW. Uterine compression sutures for preserving fertility in severe postpartum haemorrhage: An overview 13 years after the first description. J OBSTET GYNAECOL 2010; 30:339-49. [DOI: 10.3109/01443611003650233] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- C. Fotopoulou
- Department of Gynecology and Obstetrics, Charité, Campus Virchow Clinic, University Hospital, Berlin, Germany
| | - J. W. Dudenhausen
- Department of Gynecology and Obstetrics, Charité, Campus Virchow Clinic, University Hospital, Berlin, Germany
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