Use Of Uterine Compression Sutures Research Articles

Necrosis uterina tras sutura de compresión hemostática: reporte de caso y revisión de la literatura

To present a case of uterine necrosis following hemostatic suturing to control postpartum bleeding, and to review the literature in order to identify the suture techniques employed, clinical findings, diagnostics and treatment in the clinical cases described. A 34-year-old woman presenting with abdominal pain eight days after cesarean delivery due to placenta previa who required B-Lynch compression suture due to uterine atony, and who was diagnosed with uterine necrosis. The patient underwent total abdominal hysterectomy with a satisfactory recovery. A systematic literature search was conducted in the Medline vía Pubmed, Embase and Web of Science databases. The search included case series and reports, and cohorts of women with uterine necrosis following the use of uterine compression sutures for postpartum bleeding. The analysis included sociodemographic and clinical variables at the time of diagnosis, suturing technique, diagnostic tests and treatment. Overall, 23 studies with 24 patients were included. Of all necrosis cases, 83% occurred following cesarean section. B-Lynch was the suturing technique most frequently used (66 %), followed by the Cho suture (25 %). The most frequent symptoms were fever and abdominal pain. The most commonly used diagnostic test was computed tomography (9/24 cases). Hysterectomy was performed in the majority of cases (75 %). Although rare, uterine wall necrosis is a serious complication. It would be advisable to design follow-up cohort studies of women undergoing these procedures in order to determine the incidence of associated complications.

Uterine Compression Sutures in Controlling Postpartum Haemorrhage: A Narrative Review.

Postpartum haemorrhage is still the main cause of maternal morbidity and mortality. Many treatments are available, butthey may threaten fertility potential. As a uterine sparing procedure, we aimed to review uterine compression sutures in order to betterunderstand when they should represent an appropriate option. A comprehensive search in MEDLINE and PubMed databases including the terms 'postpartum haemorrhage'and 'uterine compression sutures' was performed. Results were revised and articles reviewing or presenting case reports of uterinecompression sutures to treat postpartum haemorrhage were included. The first description of uterine compression sutures to control postpartum haemorrhage was published in 1997, by B-Lynch etal. After this publication, many others have reported successful management of postpartum haemorrhage with different suturing techniques.Most of them describe success rates above 75% and the possibility of fertility preservation, with cases of uneventful pregnancyafter uterine compression sutures already published. Complications associated with each technique are rare. Reports of use of uterine compression sutures include small series of cases or even single case reports which limits thequality of existing evidence to support one technique over another. Nevertheless, uterine compression sutures are recognized as aneffective surgical conservative strategy to control postpartum haemorrhage due to uterine atony and its use is recommended, if possible,prior to hysterectomy. Uterine compression sutures are effective, safe and simple to perform in an emergent situation and preserve fertilitypotential in cases of postpartum haemorrhage.

Efficacy of Hayman Suture in the Treatment of Atonic Postpartum Hemorrhage

Purpose: The study aims to investigate the effectiveness of Hayman’s suture in the management of Atonic postpartum hemorrhage. Subjects and Method: The study includes 37 patients who developed severe atonic PPH not responsive to pharmacological measures at the Department of Obstetrics and Gynecology at Aswan University hospital, in the period between Mars 2018 and December 2019. This is a case series study of 37 patients upon whom Hayman suture is applied when failed to respond to medical management, step-wise devascularization of the uterus is attempted when the suture cannot control the bleeding alone, reserving hysterectomy as a last resort when all measures are failed. Results: Results of the research None of the 37 patients of our study required hysterectomy to control the bleeding, Hayman suture succeeded solely to arrest the hemorrhage in 30 patients (81.1%), while 7 patients(18.9%) required step-wise devascularization of the uterus with Hayman suture to stop the bleeding. It is not uncommon for complications to be described with the use of uterine compression sutures. In our study, we did not report any complications. Conclusion: The application of Hayman’s suture is a fast, efficient, non-complex, lifesaving and fertility-sparing technique to control atonic postpartum hemorrhage.

Towel Uterus Model for Uterine Compression Sutures Technical Skills Training: A Review of Literature and Development of a Performance Rubric.

Postpartum hemorrhage (PPH) continues to be the leading cause of maternal mortality worldwide, occurring in about five percent of deliveries. The most common cause of PPH is uterine atony, and a number of medical and surgical management techniques are available to prevent morbidity and mortality associated with PPH in this context. Uterine compression sutures provide a more conservative surgical approach, allowing for the preservation of fertility. Obstetrics and Gynecology (Ob/Gyn) residents need to be adequately trained to competently perform this technique.The goal of this surgical skills training is for Ob/Gyn residents to be able to surgically manage PPH using uterine compression sutures. A uterine towel model for surgical skills training in the use of uterine compression sutures was developed. The simulator is explained and compared to similar models. Possible ways to implement and use the simulator in a simulation curriculum are also described. A performance-based assessment rubric was also developed in order to formatively aid with the learning and understanding of the technique. Much work is still needed to test the validity and reliability of this tool, but based on current literature, results may be promising.

Investigation of perioperative complications associated with use of uterine compression sutures.

To assess the association between use of uterine compression sutures (UCSs) and postoperative complications. In a retrospective analysis, data were reviewed from cesarean deliveries at a medical center in Osaka, Japan, between January 2011 and March 2016. The deliveries were divided into elective and emergency cesarean groups. For each group, data on postoperative complications were compared between patients with UCSs and those without UCSs but at least 1500mL of blood loss. Data from 158 patients were included in the study. No severe complications were observed. Among the patients who underwent elective cesarean, no differences were observed between the UCS and non-UCS groups in the frequency of postoperative endometritis (3/28 [10.7%] vs 6/54 [11.1%]; P=0.957) or ileus (2/28 [7.1%] vs 3/54 [5.6%]; P=0.776). After emergency cesarean, postoperative endometritis was significantly more common in the UCS than in the non-UCS group (8/39 [20.5%] vs 4/37 [10.8%]; P=0.021), but the frequency of ileus did not differ (1/39 [2.6%] vs 2/37 [5.4%]; P=0.61). Use of UCSs during emergency cesarean delivery might increase the risk of postoperative endometritis.

Uterine compression sutures for postpartum hemorrhage: an overview

In 1997, B-Lynch pioneered the use of uterine compression sutures for postpartum hemorrhage. Since then, some researchers, including ourselves, have devised various uterine compression sutures. High-level evidence has not been demonstrated as to whether compression sutures achieve better and safer hemostasis for postpartum hemorrhage than other methods, and, if they do, whether one suture is more efficient and safer than another. However, generally speaking, uterine compression sutures have achieved hemostasis while preserving fertility in many women and thus their efficacy and safety have been time-tested. Each suture has both merits and drawbacks: obstetricians must be aware of the fundamental characteristics of various sutures. In this review, we summarize the technical procedures, efficacy, safety and complications of various uterine compression sutures. We add our own experiences and opinions where necessary.

The difficult pph- experience of combined use of B-lynch brace suture and intrauterine Bakri Balloon York hospital

The rate of life-threatening haemorrhage (blood loss 2.5 litres or more or women who received more than 5 units of blood transfusion or women who received treatment for coagulopathy after...

Uterine compression sutures for postpartum hemorrhage: is routine postoperative cavity evaluation needed?

Postpartum hemorrhage due to uterine atony continues to be one of the major causes of maternal morbidity and mortality. Several uterine compression suture techniques have been described and are increasingly being used worldwide as a conservative approach. However, little is known about the long-term effects on the uterine cavity, as well as fertility and pregnancy outcomes. We reviewed the reported complications and uterine findings after the use of compression sutures, both in examinations to evaluate the cavity (hysteroscopy, hysterosalpingography or sonohysterography) and at cesarean section, in order to assess the possible usefulness of routine postoperative cavity evaluation. Overall, the use of uterine compression sutures is effective and safe; however, some severe and potentially life-threatening complications have been reported and could possibly have been prevented if uterine cavity evaluation had been performed. Routine follow-up, both by hysteroscopy and an imaging technique, seems worthwhile.

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Treatment outcome of uterine compression sutures for massive postpartum hemorrhage

Objective: Uterine compression sutures such as modified B-Lynch suture or multiple square-shaped sutures of uterine body are simple methods for control of postpartum hemorrhage refractory to medical treatment. We evaluated the treatment outcome and morbidity of uterine compression sutures and analyzed clinical findings of patients undergone uterine compression sutures and postpartum hysterectomy. Methods: From January 2005 through December 2008, we retrospectively reviewed the medical records of patients undergone uterine compression sutures or postpartum hysterectomy. We analyzed success rates of preserving uterus of uterine compression sutures according to operative indications and mode of delivery and compared maternal characteristics, operative findings, morbidities and mortality with those of postpartum hysterectomy. Results: The frequency of uterine compression sutures for control of massive postpartum hemorrhage was 0.24% (73/30,677). The success rates of preserving uterus were 85.1% in uterine atony, 80.9% in placenta previa, and 40.0% in placenta accreta (P=0.051). The rates of preserving uterus of uterine compression sutures after vaginal delivery and cesarean section were 50.0% and 82.6%, respectively (P=0.164). The frequencies of postoperative morbidities such as disseminated intravascular coagulation, pulmonary edema, ileus were not different between immediate hysterectomy and hysterectomy after uterine compression sutures. There was no maternal mortality. Conclusion: Uterine compression suture was successful method for control of postpartum hemorrhage resulting from uterine atony and placenta previa. We suggest the use of uterine compression sutures as the first-line operation for control of postpartum hemorrhage.

Transverse annular compression sutures in the lower uterine segment to control postpartum hemorrhage at cesarean delivery for complete placenta previa

Complete placenta previa (CPP) is an important cause of life threatening postpartum hemorrhage (PPH) [1]. Bleeding can be severe and uncontrollable because there is less musculature in the lower uterine segment. The aim of the present study was to retrospectively evaluate the efficacy of transverse annular compression sutures (TACS) in achieving hemostasis after traditional conservative methods had failed to control bleeding during cesarean delivery in women with CPP. A total of 41 pregnant women with CPP were included in the study. Eligibility criteria were: (1) persistent bleeding from the separated placental surface of the lower uterine segment at cesarean delivery after successive use of uterotonics, local suturing, and ligation of uterine arteries; and (2) subsequent administration of either uterine packing (UP) or TACS (Fig. 1). There were 24 patients in the UP group and 17 patients in the TACS group. Primary outcome was blood loss reported at the different phases of the cesarean delivery procedure. Pb0.05 was considered statistically significant. Differences between the 2 groups were assessed using the t test, χ or Fisher exact tests. The Institutional Ethical Committee approved the study. There was no significant difference at baseline in age, body mass index (calculated as weight in kilograms divided by height in meters squared), gravidity, parity, gestational age at delivery, birth weight, doses of uterotonics, and incidence of placenta accreta (Table 1). Overall, there was greater blood loss throughout the cesarean delivery procedure in the UP group compared with the TACS group (1670.0±447.7 mL vs 978.2±142.9 mL; Pb0.05). No difference in blood loss was found between the groups both before and after the intervention (The intervention was defined as either uterine packing or TACS in the study). The difference in blood loss occurred during the intervention, with 845.8±311.3 mL of blood loss in the UP group compared with 142.9±64.5 mL in the TACS group (Pb0.05). Interestingly, the time taken to perform uterine packing was significantly longer than the time taken to perform TACS (22.0± 5.6 min vs 2.9±1.0 min; Pb0.05). The quantity of blood transfused was also significantly higher in the UP group than in the TACS group (1541.7±792.3 mL vs 1008.3±516.0 mL; Pb0.05). Hysterectomy was unavoidable in 2 (8.3%) patients in the UP group because of intractable bleeding. TACS failed to stop bleeding in 1 (5.9%) patient in the TACS group and the patient's uterus was preserved using multiple uterine compression sutures. Ultrasound results showed no uterine abnormalities on day 42 post delivery in the TACS group. No difference was found in the incidence of complications between the 2 groups. Normal menstruation resumed for all women, except for those who underwent hysterectomy. It is difficult to control the bleeding from the separated placental surface during cesarean delivery inwomenwith CPP [2,3]. The present study indicates that both UP and TACS were effective in controlling bleeding. The success rates (i.e., achievement of hemostasis) were 91.7% and 94.1% for UP and TACS, respectively. However, the mean blood loss during cesarean delivery and the quantity of blood transfused were higher in the UP group than in the TACS group. A partial explanation might be that the greater blood loss was related to the longer time taken to complete the intervention since it took more time to performuterine packing than to performTACS. Furthermore, in the only participant for whom TACS failed to control bleeding, the uterus was successfully preserved using another technique. Hysterectomy was required for the 2 patients in whom uterine packing was ineffective. TACS may be particularly useful in low-resource areas because it is technically less challenging and requiresminimal training and equipment. In 1997, B-Lynch et al. [4] first described the use of uterine compression sutures to treat PPH, primarily for uterine atony. In placenta previa cases, B-Lynch suturingwas described following afigure-of-eight suture in the lower uterine segment. Hwu et al. [3] andHayman et al. [5] International Journal of Gynecology and Obstetrics 108 (2010) 247–257BRIEF COMMUNICATIONS

Uterine Compression Sutures as an Alternative to Hysterectomy for Severe Postpartum Hemorrhage

Objective: To assess the use of B-Lynch type uterine compression sutures as an alternative to hysterectomy for severe postpartum hemorrhage (PPH) due to uterine atony.Methods: The use of uterine compression sutures for severe postpartum hemorrhage was reviewed over a 30-month period (January 2000-June 2002) in a tertiary obstetric unit.Results: In 7 cases of uterine atony at the time of Caesarean section, which were unresponsive to all oxytocic agents, a B-Lynch type compression suture was used before resorting to hysterectomy. In 6 of the 7 women, the bleeding was controlled with the suture, while the other required hysterectomy.Conclusion: At the time of writing there were 6 reports in the literature involving a total of 20 women who were successfully treated with this type of compression suture for severe atonic PPH. Our review adds 7 cases and found that the B-Lynch compression suture is easy to apply and should be considered in cases of severe atonic PPH when oxytocic agents fail, and before resorting to hysterectomy.