We read with interest the article by Akbayir et al. [1], ‘‘single square hemostatic suture for postpartum hemorrhage secondary to uterine atony’’. They devised a ‘‘novel’’ uterine compression suture (Akbayir suture), a single square hemostatic suture (Fig. 1a). After performing bilateral uterine artery ligation, 11 patients with intractable postpartum hemorrhage (PPH) received this compression suture, with all achieving hemostasis. The authors claimed that this suture is effective and safe for treating intractable PPH. As Hayman et al. [2] and we [3, 4] pointed out, B-Lynch suture [5] and Hayman suture [2] have some pitfalls: longitudinal threads tend to slide off, thus resulting in insufficient compression. Akbayir suture overcomes this drawback, similar to Matsubara–Yano (MY) suture [3, 4, 6]. The original MY suture consisted of three longitudinal and two transverse transfixing sutures; the latter not only compressing the uterus but also preventing longitudinal threads from sliding off [3, 4, 6]. Recently, in some occasions, we use two, and not three, longitudinal sutures, with its resultant feature shown in Fig. 1b. While Akbayir suture used one thread and transfixed the uterus four times, MY suture used 4 threads and transfixed it 8 times. Interestingly, there is a strong similarity in resultant feature between Akbayir suture (Fig. 1a) and MY suture (Fig. 1b), suggesting that both sutures achieve hemostasis in a similar manner. In this sense, the article by Akbayir et al. [1] supports the rationale of MY suture [6]; however, we have two concerns. First, we wonder whether the atonic (floppy) uterine body ‘‘bows’’ posteriorly if the suture is tied too tightly (Fig. 1a, upper). This is theoretically possible. Akbayir et al. [1] stated, ‘‘the fundus becomes hyperflexed lying over the isthmic region’’; however, they did not explain what ‘‘hyperflexion of the fundus’’ means. Regardless whether ‘‘hyperflexion’’ means ‘‘posterior bowing’’, if ‘‘posterior bowing’’ occurs, uterine compression may become weak, leading to insufficient hemostasis. It may also prevent drainage of intrauterine blood. The same phenomenon has been observed in Hayman suture, although it was ‘‘anterior’’, and not ‘‘posterior’’, bowing [7]. Second, more importantly, Akbayir suture is fundamentally the same as the uterine compression suture published by Meydanli et al. [8] in 2008 (Meydanli suture) (Fig. 1c). Akbayir et al. [1] did not cite Meydanli suture [8]. Akbayir suture differs from Meydanli suture only in the following three minor points: compared with Meydanli suture, in Akbayir suture, (1) cesarean incision is closed after, and not before, the compression suture, (2) the first needle is put above (cephalad to) the cesarean incision, and (3) the needle is inserted at a more medial (uterine) side, but the difference is only 1–2 cm. Akbayir et al. [1] performed uterine artery ligation while Meydanli et al. [8] performed hypogastric artery ligation before the compression suture: this may not be considered as a procedural difference between them. Since the first introduction of B-Lynch suture [5], many obstetricians devised various compression sutures that were coined after the inventor. Here, some confusion has arisen. For example, we found a strong similarity between Marasinghe suture [9] and Mostfa suture [10], or rather, these S. Matsubara (&) H. Yano T. Kuwata R. Usui A. Ohkuchi Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1, Shimotsuke, Tochigi 329-0498, Japan e-mail: matsushi@jichi.ac.jp