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Abstract Background Intractable postpartum hemorrhage (PPH) during cesarean section has been a significant concern for obstetricians. We aimed to explore the effectiveness and safety of a new type of uterine compression suture, the step-wise surgical technique of knapsack-like sutures for treating intractable PPH caused by uterine atony and placenta factors in cesarean section. Methods The step-wise surgical technique of knapsack-like sutures was established on the basis of the artful combination of vertical strap-like sutures and an annular suture-ligation technique. This novel surgical technique was applied to 34 patients diagnosed with PPH during cesarean section due to severe uterine atony and placental factors in our department. The hemostatic effects, clinical outcomes and follow-up visit results were all reviewed and analyzed. Results This new uterine compression suture successfully stopped bleeding in 33 patients, and the effective rate was 97.06%. Only 1 patient failed and was changed to use bilateral uterine arterial embolization and internal iliac artery embolization. The follow-up visits indicated that 33 patients restored menstruation except for 1 who was diagnosed with amenorrhea. The gynecological ultrasound tests of all the patients suggested good uterine involutions, and they had no obvious complaints such as hypogastralgia. Conclusions This step-wise surgical technique of knapsack-like uterine compression sutures can compress the uterus completely. It is a technique that can conserve the uterus and fertility function without special equipment in caesarean section for PPH, with the characteristics of being safe, simple and stable (3 S) with rapid surgery, reliable hemostasis and resident doctor to operation (3R).

Placenta accreta spectrum disorders are associated with substantial maternal morbidity and mortality. Despite a preoperative diagnosis, the rate of complications remains high, and the condition is generally associated with the need for a hysterectomy. This study aimed to evaluate the outcomes of a new uterine-preserving technique (called the combined approach, including surgical hemostasis, bilateral ligation of the descending branches of the uterine arteries, and hemostatic external supraplacental stitch with the use of the Zhukovsky double-balloon tamponade in patients with placenta accreta spectrum disorders) during cesarean delivery in women with placenta accreta spectrum disorders vs the surgical technique used until 2014. This retrospective cohort study included 147 patients with placenta accreta spectrum disorders who were divided into 2 groups: the study group (n=95) is to undergo cesarean delivery using the combined approach, and the control group (n=52) is to undergo the surgical technique used until 2014, which included bilateral uterine artery ligation, which is the transfusion of plasma, red blood cells, platelets, and protease inhibitors. The volume of blood loss was 1.5-fold lower (P =.0010), the number of blood transfusions was 5.1-fold lower (P =.026), and the rate of bladder injuries was 19-fold lower (P =.012) in the study group than that in the control group. The duration of hospital stay after delivery was 4 days lesser (P =.001) and the number of hysterectomies was 4.5-fold lower in the study group than in the control group (P =.023). The study groups did not differ in terms of placenta accreta spectrum type. The combined approach during cesarean delivery proved to be more effective than the surgical technique used until 2014 in reducing the number of hysterectomies, blood loss volume, number of blood transfusions, and duration of hospital stay in patients with placenta accreta spectrum disorders. [ABSTRACT FROM AUTHOR]

Background: Intractable postpartum hemorrhage (PPH) during cesarean section has been a significant concern for obstetricians. We aimed to explore the effectiveness and safety of a new type of uterine compression suture, the step-wise surgical technique of knapsack-like sutures for treating intractable PPH caused by uterine atony and placenta factors in cesarean section. Methods: The step-wise surgical technique of knapsack-like sutures was established on the basis of the artful combination of vertical strap-like sutures and an annular suture-ligation technique. This novel surgical technique was applied to 34 patients diagnosed with PPH during cesarean section due to severe uterine atony and placental factors in our department. The hemostatic effects, clinical outcomes and follow-up visit results were all reviewed and analyzed. Results: This new uterine compression suture successfully stopped bleeding in 33 patients, and the effective rate was 97.06%. Only 1 patient failed and was changed to use bilateral uterine arterial embolization and internal iliac artery embolization. The follow-up visits indicated that 33 patients restored menstruation except for 1 who was diagnosed with amenorrhea. The gynecological ultrasound tests of all the patients suggested good uterine involutions, and they had no obvious complaints such as hypogastralgia. Conclusions: This step-wise surgical technique of knapsack-like uterine compression sutures can compress the uterus completely. It is a technique that can conserve the uterus and fertility function without special equipment in caesarean section for PPH, with the characteristics of being safe, simple and stable (3 S) with rapid surgery, reliable hemostasis and resident doctor to operation (3R). [ABSTRACT FROM AUTHOR]

Objective: To compare H‐Hayman, a modified uterine compression suturing technique (UCS) that we describe for the first time in the literature, with conventional vertical UCS techniques. Methods: The H‐Hayman technique was used in 14 women and the conventional UCS technique in 21 women. In order to provide standardization in the study, only patients who had developed upper‐segment atony during cesarean section were recruited for the study. Results: Bleeding control was achieved in 85.7% (12/14) of the cases using the H‐Hayman technique. In the remaining two patients with persistent hemorrhage in this group, bleeding control was provided with bilateral uterine artery ligation, and a hysterectomy was avoided in all cases. With the conventional technique, bleeding control was achieved in 76.1% (16/21) of the patients, and the overall success rate was 95.2% after bilateral uterine artery ligation in those with persistent hemorrhage. In addition, the estimated blood loss and the need for erythrocyte suspension transfusion were significantly lower in the H‐Hayman group (P = 0.01 and P = 0.04, respectively). Conclusion: We found the H‐Hayman technique to be at least as successful as conventional UCS. In addition, patients who underwent suturing with the H‐Hayman technique had less blood loss and a lower requirement for erythrocyte suspension transfusion. Synopsis: The H‐Hayman technique is at least as successful as conventional uterine compression suture techniques. [ABSTRACT FROM AUTHOR]

Objectives Various procedures have been introduced to achieve hemostasis for postpartum hemorrhage (PPH) in placenta previa (PP). This study attempted to clarify the effectiveness of the combined use of three hemostatic procedures: Matsubara-Takahashi cervix-holding (MT-holding), intrauterine balloon (IUB), and uterine compression suture (UCS). Study design This was a historical cohort study on the hemostatic effect of combined procedures for patients with placenta previa (PP) undergoing cesarean section between April 2006 and December 2018. Until 2011 (2006–2011), we used MT-holding alone, whereas since 2012 we have also been using IUB and UCS: MT-holding alone was used in the former period whereas three procedures (MT-holding, IUB, UCS, and their combinations) have been used in the latter period. Perinatal outcomes were compared between 2006–2011 (before group) and 2012–2018 (after group). Results Of 416 patients with PP, excluding 273 patients with cesarean hysterectomy or no hemostatic procedure, the remaining 143 patients were analyzed. In the after group, intraoperative blood loss, the percentage of patients with postoperative blood loss ≥ 500 ml, and incidence of autologous blood transfusion were significantly lower than in the before group. Multivariate analysis showed that postoperative blood loss ≥ 500 ml decreased in the after group (adjusted OR: 0.3, 95%CI: 0.1–0.8, compared with the before group). Conclusion PPH decreased after introducing the combination of hemostatic procedures in patients with PP. Further studies are needed to determine the best combination and optimal indication for combining hemostatic procedures for PP. [ABSTRACT FROM AUTHOR]

Objective To report the technique and outcomes of a surgical care bundle, which preemptively and prophylactically reduces intrapartum bleeding during cesarean sections for these conditions and hence reducing the risk for a cesarean hysterectomy. Methods In this report, we present the surgical and clinical outcomes of a case series of 16 patients presenting with a morbidly low or adherent placenta on whom this technique was piloted. Results Seven of the sixteen patients (44%) required a blood transfusion ranging from 1 to 5 units of packed RBCs. None of the neonates required neonatal unit admissions. One woman had a subsequent pregnancy, with normal placentation and an uncomplicated delivery by cesarean section. None of the patients in our series had a hysterectomy, needed to return to theater after the initial surgery or had secondary postpartum hemorrhage. Conclusions The ElNoury–Webster Bundle is a stepwise surgical technique for the conservative management of morbidly low or adherent placenta particularly in low and middle-income healthcare settings. Objective To report the technique and outcomes of a surgical care bundle, which preemptively and prophylactically reduces intrapartum bleeding during cesarean sections for these conditions and hence reducing the risk for a cesarean hysterectomy. Methods In this report, we present the surgical and clinical outcomes of a case series of 16 patients presenting with a morbidly low or adherent placenta on whom this technique was piloted. Results Seven of the sixteen patients (44%) required a blood transfusion ranging from 1 to 5 units of packed RBCs. None of the neonates required neonatal unit admissions. One woman had a subsequent pregnancy, with normal placentation and an uncomplicated delivery by cesarean section. None of the patients in our series had a hysterectomy, needed to return to theater after the initial surgery or had secondary postpartum hemorrhage. Conclusions The ElNoury–Webster Bundle is a stepwise surgical technique for the conservative management of morbidly low or adherent placenta particularly in low and middle-income healthcare settings. [ABSTRACT FROM AUTHOR]

Aim: We aimed to evaluate the clinical outcomes and adverse events of preventive B‐Lynch suture performed during cesarean section in patients at a high risk of postpartum hemorrhage. Methods: This retrospective observational study included patients who underwent a cesarean section and the B‐Lynch suture at a tertiary perinatal medical center between January 2019 and May 2021. The B‐Lynch sutures were placed preventively before excessive blood loss occurred in patients with uterine atony, placental position abnormality (placenta previa and low‐lying placenta), placenta accreta, thrombocytopenia, coagulopathy, and other risk factors of bleeding. Partial compression sutures for bleeding points and vaginal gauze packing were placed if required. Results: The B‐Lynch suture was performed in 38 patients, and hysterectomy was avoided in all patients. Only one patient required intrauterine balloon tamponade as an additional treatment 5 days after the cesarean section. No apparent postoperative bleeding occurred within 2 h after the cesarean section in 35 patients (92%), and blood transfusion was avoided in 14 patients (37%). Thirty‐three adverse events occurred in 23 patients; these included an inflammatory response, hematomas, retained products of conception, and ileus in one, two, and two patients, respectively. In most cases, the events were not severe and were unrelated to the procedure. In one patient, a second‐look operation was performed and no complications were observed in the uterus and abdominal cavity. Conclusions: Preventive B‐Lynch suture seemed effective and safe after a short‐term observation. When excessive bleeding is expected during a cesarean section, an early introduction of this procedure is recommended. [ABSTRACT FROM AUTHOR]

An alternate pull‐on‐compress and pull‐on‐release suture tightening technique can be considered when a surgeon encounters difficulty when performing B‐Lynch compression suture. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the subsequent obstetrical outcome in women who received a uterine compression suture. Methods: This is a retrospective cohort study of women who received a uterine compression suture for postpartum hemorrhage (PPH) between January 2009 and December 2018 and had a subsequent pregnancy at a tertiary care hospital in India. Women who had PPH but did not receive uterine compression sutures and had a subsequent pregnancy were taken as controls. Results: Sixty‐two women had a subsequent pregnancy after uterine compression suture and were included in this study. There were no significant differences in the subsequent pregnancy outcome between the study and control groups. However, women with a history of uterine compression suture were found to have a higher incidence of dense omental adhesions (15% versus 2.8%; P < 0.001), more intrapartum blood loss (740.5 ± 491.8 ml versus 638.8 ± 194 ml; P = 0.02), and were more likely to need repeat uterine compression suture (6.7% versus 0%; P = 0.004). Conclusion: Women who received uterine compression sutures had similar obstetrical outcomes in their subsequent pregnancy compared with those who did not receive a suture for PPH management. However, they had a higher risk of dense omental adhesions, repeat uterine compression suture application, and intrapartum blood loss. Subsequent pregnancy outcome in women who received uterine compression sutures is good. However, they may have more intrapartum blood loss. [ABSTRACT FROM AUTHOR]

Abstract Background This study aimed to identify and review associations between the types of sutures used for uterine compression suture (UCS) and its outcomes in postpartum hemorrhage. Methods An electronic search using PubMed and Scopus databases was performed. We included the English articles reported from January 1, 1997, to May 31, 2017, using search words or terms regarding the types of suture and needle used for UCSs. We only included studies describing the sutures in the systematic review. Results We found 196 studies and included 76 (38.8%) in our analysis. We collected data on maternal outcomes for 924 patients and categorized them. Of the 76 studies, suture sizes 0, 1, and 2 were used in 6, 44, and 32 articles, respectively (some studies used multiple sutures). Of the 45 studies mentioning the needles, curved and straight needles were used in 35 and 10, respectively. The results of our review revealed that about 80% of previous articles used Catgut and Polyglactin 910 sutures. Because no studies that compared the efficacy of different size of sutures were identified, we investigated the differences using the cases reported in previous studies mentioned above. In the first analysis, we compared the uterine preservation rate between size 1 and size 2 sutures. We found no significant difference in uterine preservation rate (92.8%: size 1 vs. 94.2%: size 2, p > 0.05) but found significant difference in transfusion rate (62.4% vs. 79.1%, p

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Objective: Postpartum hemorrhage is a leading cause of maternal morbidity and mortality worldwide. Uterine atony is the most common cause of bleeding accounting for ∼80 % of cases of postpartum hemorrhage. To reduce maternal morbidity and mortality due to bleeding caused by uterine atony even under limited resources, a simple and effective procedure that can be easily applied by all obstetricians and junior physicians is required. The aim of this study was to evaluate the efficacy of novel three vertical compression sutures for severe postpartum hemorrhage.Design: Two vertical sutures are transfixed, one on each side of the lower uterine segment, from anterior to posterior over the bladder reflection avoiding the endometrial cavity, and tied over the fundus. The lateral sutures should be placed approximately 2 cm from the lateral edge of the lower uterus and approximately 4 cm from the cornual border, because the uterus widens upward from below. The third vertical suture is placed in the midline at the same level as the two vertical sutures, passing the endometrial cavity from anterior to posterior, and is tied in the middle of the fundus, where the three sutures are positioned side-by-side.Results: We report 25 cases of postpartum hemorrhage secondary to life-threatening severe uterine atony treated with this novel approach of using three vertical compression sutures. Success was achieved in 24/25 (96 %) of cases treated with three vertical sutures, without requiring hysterectomy except one.Conclusions: To reduce maternal morbidity and mortality, three vertical compression sutures as a novel technique, can be attempted before applying other more complex interventions. It does not require any extra skill or training, and is an ideal option as its simplicity allows it to be performed by all obstetricians, including junior obstetric staff. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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

Background: To characterize patients with retained products of conception (RPOC) in placenta previa (PP), and to determine who requires transarterial embolization (TAE) and/or hysterectomy after cesarean section (CS). We focused on RPOC in PP without placenta accreta spectrum. Methods: The retrospective cohort study was performed in patients with RPOC in PP between April 2006 and June 2019 in our institute. Results: Of 498 patients with PP, RPOC were observed in 25. The median RPOC length was 4.4 cm (interquartile range: 2.8–5.7). RPOC hypervascularity was observed in 10 (10/18, 56%) patients. Of the 25 patients, an additional hemostatic intervention (TAE and/or hysterectomy) was required in 12 (48%). The duration between CS and TAE and/or hysterectomy ranged from 0–66 days. Of those, eight (8/12: 67%) patients needed the interventions on the day of surgery (day 0). Univariate analyses showed that patients having received TAE and/or hysterectomy bled more at CS (p = 0.011) and more frequently required blood transfusions at CS (p = 0.011), and were more likely to have hypervascular RPOC (p = 0.036). Conclusion: Hypervascular RPOC and bleeding episodes at CS may predict the requirement of TAE and/or hysterectomy after CS in patients with PP.

Background: Postpartum hemorrhage (PPH) is the third leading cause of maternal death. Uterine atony is the most common cause, and surgical management is the last method for PPH. Objective: To assess operative outcomes after uterine compression suture (B-Lynch suture technique) versus cesarean hysterectomy. Materials and Methods: The comparison retrospective research evaluated the operative outcomes of the pregnant women managed by the B-Lynch suture technique (group 1) versus cesarean hysterectomy (group 2). Unique data form, designed to collect all patients involved in the present study, were reviewed and analyzed. The population study was pregnant women divided into two groups. Thirty-five patients were assigned to group 1 and thirty-five patients were assigned to group 2. The independent t-test was used to compare means of categorical variables between the two groups, with p<0.05 indicating statistical significance. Results: Twenty-three thousand two hundred fifty-eight pregnant women delivered during the study period, which was 18 years 6 months. PPH occurred in 563 patients (2.42%), in both vaginal and cesarean deliveries. Intractable PPH occurred in 177 patients (0.76%) during cesarean section. Clinical data risk factors were age, complications while receiving blood transfusion, injury to the urinary bladder, and death. Several outcomes in group 1 were better than in group 2, such as the interval of operation, blood loss, fever after surgery, and saving of life. However, three patients in the trial of B-Lynch suture were changed to hysterectomy due to curative management. Conclusion: The uterine compression suture (the B-Lynch technique) should be used promptly to manage acute PPH due to uterine atony. Additionally, a cesarean hysterectomy might be used for surgical management in the latter method, depending on the severity of the patient, the etiology of PPH, and the obstetrician's skills and experience. [ABSTRACT FROM AUTHOR]

Previously we reported laparoscopic removal of compression sutures due to uterine ischemia and related pain, which has two of the difficult aspects: (1) maneuvering the curved needle to perform compression suturing in the narrow surgical field, and (2) distinguishing between the threads of the cesarean section wound sutures versus the vertical compression sutures during removal, as the threads are the same white color. We performed vertical compression sutures for intrapartum hemorrhage with total placental previa, and modified both the needle type and the color of the thread used for uterine compression sutures during cesarean section. After the operation, we performed successful laparoscopic removal of compression sutures for postoperative focal pain. Changing the needle type and color helped to perform operations. The present case supports the concept that the laparoscopic removal of uterine compression suturing is useful for controlling pain in cases where general analgesics are ineffective.

Srisuda Songthamwat, Metha Songthamwat Department of Obstetrics and Gynecology, Udonthani Hospital, Udonthani, Thailand 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. Keywords: B-Lynch, uterine atony, cesarean section, uterine compression suture, uterine flexion suture

Objective: To compare the effects of uterine compression suture versus conventional mode of treatment for the management of postpartum haemorrhage after caesarean section. Methods: This study enrolled 84 women with postpartum hemorrhage who were admitted to Binzhou People's Hospital from August 2017 to October 2018 as the research subjects. They were divided into a control group and an observation group according to random number table method, 42 each group. The patients in the control group were treated by conventional treatment, while those in the observation group were treated by uterine compression suture. The hemorrhage, hemostasis, postoperative recovery and frequency of adverse reactions were compared between the two groups. Results: The amount of bleeding in the observation group was less than that in the control group, and the bleeding time was shorter than that in the control group; the differences had statistical significance (P<0.05). The success rate of hemostasis in the observation group was significantly higher than that in the control group, and the ineffective rate of hemostasis was significantly lower than that in the control group (P<0.05); the differences were statistically significant. The cleaning time of lochia, the recovery time of uterus and the recovery time of menstruation in the observation group were significantly shorter than that in the control group (P<0.05); the differences between the two groups were statistically significant (P<0.05). The frequency of adverse reactions in the observation group was significantly lower than that in the control group (P<0.05), and the difference was statistically significant (P<0.05). Conclusion: Uterine compression suture is effective for postpartum hemorrhage of cesarean section, which can effectively reduce postpartum hemorrhage, shorten postpartum hemorrhage time and accelerate the recovery. It is safe and worth clinical promotion. [ABSTRACT FROM AUTHOR]

Background: This study aimed to identify and review associations between the types of sutures used for uterine compression suture (UCS) and its outcomes in postpartum hemorrhage.Methods: An electronic search using PubMed and Scopus databases was performed. We included the English articles reported from January 1, 1997, to May 31, 2017, using search words or terms regarding the types of suture and needle used for UCSs. We only included studies describing the sutures in the systematic review.Results: We found 196 studies and included 76 (38.8%) in our analysis. We collected data on maternal outcomes for 924 patients and categorized them. Of the 76 studies, suture sizes 0, 1, and 2 were used in 6, 44, and 32 articles, respectively (some studies used multiple sutures). Of the 45 studies mentioning the needles, curved and straight needles were used in 35 and 10, respectively. The results of our review revealed that about 80% of previous articles used Catgut and Polyglactin 910 sutures. Because no studies that compared the efficacy of different size of sutures were identified, we investigated the differences using the cases reported in previous studies mentioned above. In the first analysis, we compared the uterine preservation rate between size 1 and size 2 sutures. We found no significant difference in uterine preservation rate (92.8%: size 1 vs. 94.2%: size 2, p > 0.05) but found significant difference in transfusion rate (62.4% vs. 79.1%, p < 0.01). With the hypothesis that non-transfusion cases were less severe, we excluded these cases from second analysis. Although our second analysis of only Catgut or Polyglactin showed strong selection bias, we observed that uterine preservation rate was significantly higher in cases with size 2 suture than in those with size 1 suture (86.9% vs. 93.5%, p = 0.033).Conclusions: Our systematic review showed that approximately 80% of cases were treated by Catgut and Polyglactin 910. Due to the heterogeneity of cases included in this review, it is difficult to estimate which suture is better for UCSs. More robust studies are necessary to enable the identification of the superior suture for performing UCSs. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of the study is to demonstrate the technique of applying Nakornping uterine compression suture after caesarean section and to evaluate the effectiveness of this surgical intervention for management of uterine atony after failed medical treatments.Materials and Methods: The medical records of 3,949 patients who had caesarean deliveries at Nakornping Hospital from October 2011 to September 2014 were retrospectively analyzed. Uterine atony occurred in 137 caesarean delivering patients. Sixty one patients with persistent uterine atony after receiving bimanual compression, uterine massage and uterotonic medications as per the hospital standard treatment protocol for postpartum hemorrhage management were treated with the placement of the Nakornping uterine compression suture. The mean time to perform the procedure was 2.2 ± 0.4 minutes.Results: For all sixty one patients receiving Nakornping uterine compression suture, the treatment was successful. Nakornping uterine compression suture was sufficient to stop the bleeding immediately in 100% of the patients. There were no complications observed either during or after the procedure. All sixty one patients had normal lochia post caesarean delivery. The patients were discharged after a median of 4 days hospital stay. When pelvic ultrasound was done on day 3 and day 7 post operations on two patients, the study showed normal uterine contour and no fluid was found in the uterine cavity. Hysterosalpingography was performed on two patients on week 6 after the procedure, the study revealed normal findings. Four patients (6.6%) had subsequent pregnancies with caesarean delivery.Conclusion: Application of Nakornping uterine compression suture was effective for treating uterine atony after caesarean section. It is a simple and rapid procedure for clinical practice.

Objective: To assess the effectiveness of uterine compression suture to control postpartum haemorrhage. Study Design: Prospective experimental case series. Place and Duration: From 1st April, 2014 to 30th April, 2017 at the Labour Ward of Federal General Hospital, Chak Shahzad, Islamabad. Methodology: All women who went into postpartum hemorrhage (PPH) after vaginal delivery or cesarean section were selected. B lynch suture was applied by obstetrician on call. Patient was kept in high dependency area for 24 hours with close monitoring. Demographic characteristics, amount of blood loss, type of intervention used to arrest bleeding and underlying cause of bleeding were noted. All cases were discharged on fifth day. They were followed up till 3 months postpartum for development of complications like secondary post-partum haemhorrhage and infections. Results: A total of 20 women underwent postpartum haemorrhage during the study period. Demographic characteristics showed that 55% of patients were young and 70% were primigravida. 70% had gestational age of 37-40 weeks. Commonest cause of haemorrhage was uterine atony (50%). Average blood loss of 1000-1500ml was noted in 45%, while 35% had blood loss range of 1500-2000 ml. Sever postpartum haemorrhage was seen in only (5%) patient, in our study. 80% required <3 blood transfusions and 20% had >3 transfusions. B Lynch suture was the only intervention in 65% of study patients while 35% had bilateral uterine arteries ligation along with application of B Lynch suture. In 70% of study patients B Lynch suture was applied during lower segment cesarean section while in 30%, emergency laparotomy was performed after vaginal delivery. Success rate of B Lynch application was 100%. Conclusion: B Lynch compression suture is effective in controlling massive haemorrhage in a very short time and success rate was 100%. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Aims: The aims of this study were to clarify: (i) the effectiveness of Matsubara-Yano uterine compression suture (MY) to achieve hemostasis in the presence of postpartum hemorrhage (PPH) during cesarean section, (ii) the type of PPH for which MY is effective, (iii) post-operative complications of MY, and (iv) outcomes of pregnancy after MY.Methods: This retrospective observational study was performed using medical records of patients for whom MY had been performed between January 1, 2009 and December 31, 2017.Results: MY was performed for 50 patients, with hemostasis achieved in 46 (92%). The other four (8%: 4/50) patients required transarterial embolization or hysterectomy. Of these four, three patients had placenta accreta spectrum (PAS) disorder-related bleeding. Post-operative complications were observed in three (6%: 3/50) patients, with all showing intrauterine infection. All three patients recovered solely with antibiotics. Eight pregnancies were confirmed (five livebirths, two spontaneous abortions in the first trimester, and one case of ongoing pregnancy). Of the five livebirths, one resulted in cesarean hysterectomy due to placenta previa with PAS disorders.Conclusions: MY had a hemostatic effect on PPH. All cases except one with hemostatic failure were associated with PAS disorders, indicating that the hemostatic rate was lower in those with PAS than non-PAS disorders. [ABSTRACT FROM AUTHOR]

Awareness of grave complications like ischemic necrosis associated with uterine compression sutures is essential for prompt diagnosis and timely management. [ABSTRACT FROM AUTHOR]

Abstract: 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Résumé Objectif L’atonie utérine est la première cause d’hémorragie de la délivrance. Lors d’une césarienne, différentes techniques chirurgicales de plicatures utérines existent lorsque les médicaments utérotoniques sont insuffisantes. Si leur efficacité est admise, peu de données concernant leurs conséquences sur les grossesses ultérieures sont disponibles. Ce travail a pour objectif l’analyse du pronostic obstétrical à long terme après plicatures utérines. Patientes et méthodes Il s’agit d’une étude rétrospective portant sur 40 cas d’hémorragie de la délivrance avec des techniques de plicatures utérines réalisées dans une maternité de niveau III, entre 2004 et 2010. L’objectif principal est l’évaluation du pronostic obstétrical des grossesses suivantes. L’efficacité et les complications des techniques chirurgicales de plicatures, selon leur caractère transfixiant ou non, ont été analysées. Résultats Onze patientes ont pu obtenir des grossesses à distance d’une plicature utérine parmi 14 femmes désireuses de grossesse. Le délai médian pour concevoir était de 27 mois (6–78 mois). Neuf patientes ont accouché à terme. Un retard de croissance intra-utérin (RCIU) et une prématurité modérée (32 SA) ont été observés dans deux autres cas. Aucun cas de placenta accreta n’a été constaté. Il n’a pas été noté de différence significative sur l’efficacité et les complications chirurgicales précoces en fonction de la technique utilisée ; néanmoins, deux complications infectieuses et ischémiques étaient observées après une plicature transfixiante. Conclusion Le pronostic obstétrical est conservé à distance d’une plicature utérine. Les techniques transfixiantes pourraient être à l’origine d’un plus grand nombre de complications ischémiques et infectieuses. Une évaluation des techniques chirurgicales selon leur caractère transfixiant ou non sur une large cohorte est nécessaire pour l’évaluation de l’influence de la technique sur la fertilité et les complications post-opératoire. 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. [ABSTRACT FROM AUTHOR]

Objectives: Various procedures have been introduced to achieve hemostasis for postpartum hemorrhage (PPH) in placenta previa (PP). This study attempted to clarify the effectiveness of the combined use of three hemostatic procedures: Matsubara-Takahashi cervix-holding (MT-holding), intrauterine balloon (IUB), and uterine compression suture (UCS)., Study Design: This was a historical cohort study on the hemostatic effect of combined procedures for patients with placenta previa (PP) undergoing cesarean section between April 2006 and December 2018. Until 2011 (2006-2011), we used MT-holding alone, whereas since 2012 we have also been using IUB and UCS: MT-holding alone was used in the former period whereas three procedures (MT-holding, IUB, UCS, and their combinations) have been used in the latter period. Perinatal outcomes were compared between 2006-2011 (before group) and 2012-2018 (after group)., Results: Of 416 patients with PP, excluding 273 patients with cesarean hysterectomy or no hemostatic procedure, the remaining 143 patients were analyzed. In the after group, intraoperative blood loss, the percentage of patients with postoperative blood loss ≥ 500 ml, and incidence of autologous blood transfusion were significantly lower than in the before group. Multivariate analysis showed that postoperative blood loss ≥ 500 ml decreased in the after group (adjusted OR: 0.3, 95%CI: 0.1-0.8, compared with the before group)., Conclusion: PPH decreased after introducing the combination of hemostatic procedures in patients with PP. Further studies are needed to determine the best combination and optimal indication for combining hemostatic procedures for PP.

Although massive haemorrhage at caesarean section (CS) for placenta praevia is a serious concern, effective treatment is not yet determined. We performed a new uterine sandwich to achieve haemostasis at CS for total placenta praevia in five consecutive cases in whom the placenta reached up to >5 cm from the internal cervical os in all directions of an uterine wall. A Matsubara-Yano (MY) uterine compression suture was placed, followed by placement of an intrauterine balloon. Haemostasis was achieved in all five cases with median blood loss of 1618 mL. No short-term adverse events were observed. The MY sandwich can be used to achieve haemostasis at CS for placenta praevia. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To determine rates of use and success of second-line therapies for massive primary postpartum hemorrhage (PPH). Methods: A retrospective cohort study was conducted among 91 women who gave birth at Kwong Wah Hospital, Hong Kong, between January 1, 2006, and December 31, 2011. Inclusion criteria were gestational age of at least 24weeks and massive PPH (defined as blood loss ≥1500mL within 24hours after birth). Second-line therapies assessed were uterine compression sutures, uterine artery embolization, and balloon tamponade after failure of uterine massage and uterotonic agents to stop bleeding. Results: The rate of massive PPH was 2.65 per 1000 births. Second-line therapies were used among 42 women with PPH, equivalent to a rate of 1.23 per 1000 births. Only 21.4% of the women who received second-line therapies required rescue hysterectomy. A rising trend was observed for the use of second-line therapies, whereas the incidence of rescue hysterectomy and estimated blood loss were found to concomitantly decrease. Conclusion: Increasing use of second-line therapies among women with massive PPH was associated with a decreasing trend for rescue hysterectomy. Obstetricians should, therefore, consider all available interventions to stop PPH, including early use of second-line options. [Copyright &y& Elsevier]

Objective: The objective of this study is to describe a novel technique for the treatment of postpartum hemorrhage and evaluate its effectiveness and safety. Methods: Single square hemostatic suture was performed for uterine atony when postpartum hemorrhage did not respond to medical therapy and bilateral uterine artery ligation. We retrospectively reviewed the data of 11 women and evaluated their endometrial cavity with hydrosonography after a follow-up period of 8-34 months. Results: The single square hemostatic suture successfully stopped bleeding in all of the cases. Of the 11 women, 2 could not be traced. Menstruation started without delay in nine women. One of the women achieved pregnancy 25 months after surgery. The six women who underwent hydrosonography had an intact endometrial cavity. Conclusions: For women who desire future fertility, and when bilateral uterine artery ligation is not sufficient to control PPH, single square suturing may be used as an effective and safe procedure. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Zheng J, Xiong X, Ma Q, Zhang X, Li M. A new uterine compression suture for postpartum haemorrhage with atony. BJOG 2011;118:370-374. 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. [ABSTRACT FROM AUTHOR]

Uterine compression suture to prevent impending recurrence of uterine inversion after laparotomy repositioning has not been reported previously. A 28-year-old primigravid woman demonstrated uterine inversion. Although Huntington's procedure had successfully repositioned the uterus, acute recurrence of inversion with uterine atony appeared to be impending during the surgery. We applied modified uterine compression sutures, which prevented the recurrence of inversion and achieved complete hemostasis. Three years later, the patient became pregnant and vaginally delivered a term infant. Thereafter, uterine inversion recurred, and was repositioned manually. Uterine compression suture may be of use not only for hemostasis for postpartum hemorrhage, but also for prophylaxis against acute recurrence of uterine inversion. [ABSTRACT FROM AUTHOR]

We have described a modification of the B-Lynch uterine compression suture which is simple and effective. This technique apposes the anterior and posterior uterine walls, obliterating the cavity and thereby provides effective control of post-partum haemorrhage as a result of uterine atony. It comprises of vertical compression sutures and is distinct from B-Lynch and Haymen's suture by having an additional firm puncture just below the uterine fundus. This means that the suture is transfixed at the uterine fundus, thus eliminating the risk of the sutures sliding off at the uterine fundus. [ABSTRACT FROM AUTHOR]

Aim: To inform about the clinical results of a new uterine compression suture technique used in the surgical management of postpartum hemorrhage due to uterine atony associated with abnormal placental adherence. Methods: Postpartum hemorrhage due to uterine atony associated with abnormal placental adherence was diagnosed in seven out of 1819 (0.38%) cesarean sections performed between January 2004 and February 2007, and a new uterine compression suture technique was used for surgical management. Age, parity, gestational age and cesarean section indications, amount of transfusion performed, length of hospital stay, postoperative complications, and number of patients in whom the uterus was preserved were evaluated. Results: The mean age of the cases was 30.5 ± 3.7 (24–35) years. Cesarean indications were previous cesarean section plus placenta previa totalis in three cases (43%), previous cesarean section in two cases (29%), a twin pregnancy as a result of in vitro fertilization–embryo transfer in one case (14%) and preterm premature rupture of membranes in one case (14%). Six out of seven cases (85%) were successfully treated with the Meydanli compression suture and the uterus was preserved. Conclusion: The Meydanli compression suture seems to be a simple, quickly applicable and safe uterine compression suture technique, which decreases maternal mortality and peripartum hysterectomy rates. [ABSTRACT FROM AUTHOR]

Objective: Placenta previa (PP) and placenta accreta spectrum (PAS) disorders are major causes of postpartum hemorrhage (PPH). There is a variety of surgical management options with inexplicit reported success rates. Uterine sandwich is a combination of uterine compression sutures and intrauterine balloon placement to achieve hemostasis. The aim of this study was to present our experience of seven women managed with a novel "lower uterine sandwich" technique to control post-cesarean hemorrhage due to PP accreta., Materials and Methods: Seven pregnant women diagnosed as having PP totalis accreta underwent a post-cesarean procedure combining bilateral ligation of the uterine artery, utero-ovarian artery, and internal iliac artery, Pereira compression sutures implemented on the uterine isthmus, Foley catheter placement into the lower uterine segment, and transvaginal cervical cerclage application, namely "Caliskan's uterine sandwich technique"., Results: All women included in this study had placental invasion abnormalities of varying degrees. Postoperative diffusion magnetic resonance imaging assessment revealed a completely normal and preserved uterine blood supply. All women menstruated regularly in their postoperative follow-up period and two women conceived again and delivered uneventfully. None of the patients experienced morbid complications nor required hysterectomy., Conclusion: This novel procedure appears to be a plausible fertility and organ-preserving option in cases of intractable PPH, particularly in lower uterine segment bleeding. This uterine sandwich technique may allow physicians to manage massive hemorrhage due to PAS conservatively by preserving the uterus and its functions without major complications.

Presents a case study of the use of a type of compression suture for postpartum hemorrhage due to placenta praevia accreta in a 37-year-old woman. Background on traditional management techniques for postpartum hemorrhage; Medical history of the patient; Results of Doppler ultrasound scans performed on the patient after the compression suture.