Removable retropubic uterine compression suture for controlling postpartum hemorrhage.

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.

Ring compression suture for controlling post-partum hemorrhage during cesarean section.

AIM: To avoid complications associated with uterine compression sutures, we devised a ring compression suture (RCS). METHODS: The RCS was performed on 12 patients with post-partum hemorrhage (PPH) during cesarean section. The suture was inserted 0.5 cm below the attachment point of the uterosacral ligament into the uterine cavity and pushed downward through the cervical canal into the vagina. The other end of the stitch was threaded through the lower abdominal wall, from the inside of the abdomen cavity to the outside of the abdominal wall, emerging at the external surface of the lower abdomen 2 cm lateral to the ventral median line and 1 cm above the symphysis pubis. Then, the two ends of the suture (the end in the vagina had been pulled out in advance) were tied tightly on the pudendum. The same stitch was repeated on the contralateral side. After 48 h postoperatively, the suture was removed through the vagina under sterilization. RESULTS: All 12 women with PPH who underwent RCS achieved hemostasis, and complications related to RCS were not seen. Two of them had successful pregnancies postoperatively. The remaining women had no desire for a further pregnancy. CONCLUSION: The procedure can be used as an alternative to peripartum hysterectomy and also as a prophylactic application in PPH.

Longitudinal parallel compression suture to control postopartum hemorrhage due to placenta previa and accrete.

OBJECTIVE: To assess the efficacy and safety of longitudinal parallel compression suture to control heavy postpartum hemorrhage (PPH) in patients with placenta previa/accreta. MATERIALS AND METHODS: Fifteen women received a longitudinal parallel compression suture to stop life-threatening PPH due to placenta previa with or without accreta during cesarean section. The suture apposed the anterior and posterior walls of the lower uterine segment together using an absorbable thread A 70-mm round needle with a Number-1 absorbable thread was used. The point of needle entry was 1 cm above the upper margin of the cervix and 1 cm from the right lateral border of the lower segment of the anterior wall. The suture was threaded through the uterine cavity to the serosa of the posterior wall. Then, it was directed upward and threaded from the posterior to the anterior wall at ∼1-2 cm above the upper boundary of the lower uterine segment and 3-cm medial to the right margin of the uterus. Both ends of the suture were tied on the anterior aspect of uterus. The left side was sutured in the same way. RESULTS: The success rate of the procedure was 86.7% (13/15). Two of 15 cases were concurrently administered gauze packing and achieved satisfactory hemostasis. All patients resumed a normal menstrual flow, and no postoperative anatomical or physiological abnormalities related to the suture were observed. Three women achieved further pregnancies after the procedure. CONCLUSION: Longitudinal parallel compression suture is a safe, easy, effective, practical, and conservative surgical technique to stop intractable PPH from the lower uterine segment, particularly in women who have a cesarean scar and placenta previa/accreta.

Uterine folding hemostasis: a simpler and safer technique for controlling atonic postpartum hemorrhage.

OBJECTIVE: To observe the efficacy and safety of a uterine folding hemostatic technique in controlling atonic postpartum hemorrhage (PPH) during cesarean delivery. METHODS: Thirty-nine women with severe postpartum bleeding from uterine inertia, which did not react to conventional initial management protocols, underwent a uterine folding hemostasis. The procedure was to fold the uterine fundus onto the anterior wall of the corpus uterus using an absorbable suture that thread tautly through the inner myometrial layer of the uterus 1-3 cm below the fundus (not entered into uterine cavity) and 1-2 cm above and below the CS incision (entered into uterine cavity 2-4 cm medal to bilateral border of the uterus). RESULTS: The technique was sufficient to stanch bleeding immediately in 32 patients (82.1 %). Seven women underwent hypogastric arteries ligation (1 case) or uterine arterial embolization (6 cases) because of continuous bleeding after the procedure. There were no morbidities or abnormalities of the uterus in these 32 patients. Eight women had pregnancies after this hemostasis and the others lacked the desire for future pregnancy. CONCLUSION: Uterine folding hemostasis is a simple, safe and effective technique to control the atonic PPH.

Reflexed Compression Suture for the Management of Atonic Postpartum Hemorrhage with an Abnormally Adherent Placenta.

BACKGROUND/AIMS: Postpartum hemorrhage (PPH) is a life-threatening condition with a worldwide occurrence. The purpose of this study is to evaluate the efficacy and safety of a reflexed compression suture in controlling severe atonic PPH with placenta accreta. METHODS: Eleven women with severe PPH due to uterine inertia or placenta accreta were administered the reflexed compression suture. The procedure was to reflex the fundus onto the anterior wall of the uterus for compressing hemostasis and to form a 'belt-like' binding suture to reinforce the effectiveness of pressing the myometrium. RESULTS: Ten of the 11 women (90.9%) were successfully treated with the suture, and the uterus was preserved. None of these patients developed complications related to this method. Only in 1 patient with placenta increta could the bleeding not be stanched, and a peripartum hysterectomy was performed. Two women had pregnancies after the suture. CONCLUSION: The reflexed compression suture is a simple, swift, safe and effective technique of controlling uterine atonic bleeding, particularly in patients with an abnormally adherent placenta. The advantage of not having to conduct a hysterotomy also lies in reducing the duration of anesthesia and blood loss.

Symbol "&" suture to control atonic postpartum hemorrhage with placenta previa accreta.

OBJECTIVE: To evaluate the efficacy and safety of a symbol "&" compression suture technique in controlling severe atonic postpartum hemorrhage with placenta previa accreta during cesarean delivery. METHODS: Nine women with heavy postpartum bleeding from uterine inertia and placenta previa percret, which did not react to conventional initial management protocols, were underwent the suture in the shape of symbol "&" in China Meitan General Hospital. The suture procedure was to staple the anterior and posterior walls (of the lower uterine segment as well as corpus uterus) together using number 1 chromic catgut, with a cross at about 2 cm above the upper boundary of lower uterine segment. RESULTS: Symbol "&" compression suture was capable of stanching the postpartum hemorrhage immediately in all nine women. None of these patients developed complications related to this method. Subsequent pregnancies after the suture were occurred in two women and delivered with repeat cesarean section. CONCLUSION: Symbol "&" compression suture is a simple, safe and highly effective technique to control the treatment-resistant uterine atonic bleeding, particularly in previous cesarean scar at lower segment and placenta previa accreta.