Authors response to: The Hayman’s technique: a simple method to treat postpartum haemorrhage

Abstract

We are grateful to Dr Verkuyl for reporting this clinical case that emphasises the importance of simple and effective emergency measures to treat massive uncontrolled postpartum haemorrhage (PPH) particularly in low-resources countries where emergency obstetric care is not available. Women in the developing world are approximately 100 times more likely than those in developed countries to die from PPH and active attempts have been made by healthcare providers in these settings to introduce low-cost and low-tech alternatives to major surgery (e.g. condom catheters as uterine tamponade). The application of a tourniquet around the uterus as described by Dr Verkuyl could either reduce the blood flow to the uterus or apply transverse compression to control bleeding from the lower uterine segment. Although with life-saving potential this procedure runs the risk of ischaemic uterine necrosis and of blood being trapped within the uterine cavity instead of being expelled freely through the vagina. Such an emergency measure could have a role only under extreme circumstances to stabilise women and to gain time when immediate back up and basic essential care are not available in the presence of intractable PPH. Uterine compression sutures offer the advantage of exerting direct compression without interfering with the blood supply to the uterus. Placement of Haymans suture is inexpensive (several different suture materials have been successfully used) fast easy to master and of proven efficacy. It can therefore be considered an ideal treatment option for PPH even in places where there are few resources and few facilities. The use of simple supplies such as a Foley catheter tied around the uterus can be a further option to accomplish a vital task such as the control of bleeding particularly in rural areas of low-income countries. (full text)