A uterus-saving procedure for postpartum hemorrhage

Abstract

Uterus compression sutures are a simple, lifeand uterus-saving procedure in severe postpartum hemorrhage when conservative management has failed. Postpartum hemorrhage is one of the leading causes of maternal death worldwide, ranging from one in 1000 deliveries in the developing countries to one in 100 000 in the developed countries w1x. Traditional management includes uterine massage, use of uterotonics, embolization or ligation of the internal iliac or uterine artery, and, finally, hysterectomy. A surgical alternative for hysterectomy has recently been proposed w2,3x. However, the procedure originally described and its modifications are rather complex. A 34-year-old woman was transferred to the Antwerp University Hospital for intractable vaginal bleeding. The patient had undergone a second uncomplicated cesarean delivery 9 days earlier, with a visually complete removal of the placenta. She was considered to have no history of coagulopathy, although she was not initially tested because this was her second cesarean delivery. On ultrasound exploration she had an accumulation of echogenic structures in the uterus and retained