Uterine Compression Sutures Research Articles

Evaluation of uterine cavity and blood flow after conservative surgical management of placenta previa /accrete (Cross Sectional Study)

The aim of the work is aiming at determining the impact on Fertility and pregnancy outcomes of uterine artery ligation or Compression sutures for severe PPH based on a large single-center cohort, The secondary objectives were to compare maternal long term. 4 18 cases continued the follow up at 6 month Two out of 47 cases of the follow up got pregnant after 3 months postpartum by asking them by telephone and confirmed positive pregnancy tests. 6 months postpartum 5 women got pregnant .3 of the 7 cases we could follow up by telephone and they got delivered at GA of 38 w by elective C.S with no recurrence of placenta previa or accrete and no post-operative complications and for luck one of those we followed up at 3 month and moderate adhesions were found in office hysteroscopy and followed her by telephone by asking on her menstrual pattern which was irregular at first for 2months and regulated by hormonal treatment after which she got pregnant and was followed up for recurrence of placenta previa or accrete but her placenta was normal situated and underwent an elective C.S at 38 weeks with no postoperative or intraoperative complications .

Post-Partum Hemorrhage in Khost Post Graduate Medical Education Hospital

The leading cause of maternal deaths in both industrialised and developing nations is Post-Partum Haemorrhage (PPH). It results from deviations in one of four fundamental processes, with uterine atony constituting the majority of cases. It's crucial to have a diverse approach to management. It is considered the importance of oxytocin and prostaglandins, such as misoprostol, in therapy. Uterine tamponade and compression sutures, two recently created, less invasive therapeutic options, are quickly emerging as viable substitutes for the conventional procedures of pelvic devascularization and hysterectomy. Public health initiatives and medical measures meant to reduce maternal mortality from PPH, which differs significantly across developing and industrialised nations, are further examined.
 Dr. Sakhi Sardar and Dr. Sherzad Gul Sharif did this prospective observational research in the department of obstetrics and gynaecology at the Khost Provincial Hospital in Afghanistan. There were a total of 80 instances of Post-Partum Haemorrhage that met the criteria for inclusion. Data were gathered and examined in PPH patients who had both medicinal and surgical treatment.
 In the current research, more than 50% of patients needed blood and blood products, and 60% of cases were multigravida. The majority of Post-Partum Haemorrhage (PPH) cases in the current research were treated medically. uterine toxins (42.5 %) Early detection and prompt intervention made this feasible.
 In every situation, active management of the third stage of labour is advised. 70% of patients were handled medically, while the remaining 30% needed surgical intervention. Uterotonic medications and bimanual uterine compression were employed in medical care, although cervical and vaginal laceration repair was mostly needed in surgical management.

Obstetric hemorrhage and surgical emergencies training workshops on fresh cadavers and simulators result in high application in daily practices and decreased patient referral.

Objective:In this study, we aimed to evaluate the effects of obstetric emergencies workshops combining theoretical lectures, simulation trainers and fresh cadaver models on daily practices and referrals of obstetrics and gynecology specialists.Materials and Methods:This is a prospective observational study involving obstetrics and gynecology specialists attending the Turkish Society of Obstetrics and Gynecology endorsed obstetrics hemorrhage management courses held in 2018 and 2019. The training course is an annually organized two-day course, one day allotted to theoretical lectures and the other day to practical training on both simulators and fresh cadavers. Trainees participating in the course was surveyed with an anonymous questionnaire on their motivation to attend the course and their juridical history of obstetric patient management. Attendees were asked to disclose whether they had ever independently performed the procedures stated in the questionnaire or not, before commencing the course and 1 year after attending the course.Results:Among the attendees 22% (n=32) had at least one obstetrical malpractice lawsuit and 36.1% (n=52) were accused of Health Care Complaints Comission. The main motivation of the attendees for taking this course was Professional development followed by reducing maternal mortality and morbidity and avoiding malpractice. One year after the course, attendees applying uterine devascularization surgery increased by 36.1% (52/144), uterine compression sutures increased by 52.7% (76/144), and ability to apply uterine balloon tamponade increased by 59.7% (86/144). Besides improvement in other obstetric surgical skills an indirect effect seen that the attandees operated on high-risk cases increased in placenta previa (15.3%), placenta acreata spectrum (30.5%), operative deliveries (27.7%), peripartum hysterectomy (24.9%) and relaparotomy for postpartum hemorrhage (34.7%).Conclusion:Opportunities of attending well organized fresh cadaveric workshops on managing postpartum hemorrhage and other obstetric surgeries, can quickly adapt to daily practice, restore the professional confidence of obstetric and gynecology specialists, and eventually decrease patient referral.

Impact of the introduction of a low-cost uterine balloon tamponade (ESM-UBT) device for managing severe postpartum hemorrhage in India: A comparative before-and-after study.

To evaluate the impact of introducing a uterine balloon tamponade (ESM-UBT) device for managing severe postpartum hemorrhage (PPH), mainly due to uterine atony, in health facilities in India on the rates of PPH-related maternal death and invasive procedures for PPH control. We used a quasi-experimental, difference-in-difference (DID) design to compare changes in the rates of a composite outcome (PPH-related maternal death and/or artery ligation, uterine compression sutures, or hysterectomy) among women delivering in nine intervention facilities compared with those delivering in two control facilities, before and after the introduction of ESM-UBT. The study sample included 214 123 deliveries (n=78 509 before ESM-UBT introduction; n=47 211 during ESM-UBT introduction; and n=88 403 after ESM-UBT introduction). After introduction of ESM-UBT, there was a significant decline in the rate of the primary composite outcome in intervention facilities (21.0-11.4 per 10000 deliveries; difference -9.6, 95% confidence interval -14.0 to -5.4). Change in the rate of the primary composite outcome was not significant in control facilities (11.7-17.2 per 10000 deliveries; difference 5.4, 95% confidence interval -3.9 to 14.9). DID analyses showed there was a significant reduction in the rate of the primary composite outcome in intervention facilities relative to control facilities (adjusted DID estimate -15.0 per 10000 points, 95% confidence interval -23.3 to -6.8; P=0.005). Introduction of the ESM-UBT in health facilities in India was associated with a significant reduction in PPH-related maternal death and/or invasive procedures for PPH control.

Conservative Surgical Management of Early Postpartum Hemorrhage: A 12-Year Experience in a Tertiary Care Center in the South of Thailand.

To evaluate the success rate and predictive factors of success in conservative surgical management of early postpartum hemorrhage (PPH). A retrospective study was conducted at a tertiary care hospital in the south of Thailand, from January 2006 to December 2017. PPH with conservative surgical management including Bakri balloon tamponade, B-Lynch uterine compression sutures, arterial embolization, vessel ligations, and combined surgical procedures was reviewed. The procedures were considered successful if bleeding could be controlled without subsequent hysterectomy. Multivariate logistic regression analysis was used to identify predictive factors for success of conservative surgical treatment. Among 39,327 deliveries, 1461 (3.7%) patients had early PPH, and 92 cases received conservative surgical management. Most patients (92.4%) underwent cesarean section. Median (IQR) blood loss before conservative surgery was 1800 (1100, 2575) mL, and median (IQR) time from early PPH to conservative surgical management was 41 (25.5, 60.0) minutes. The overall success rate of conservative surgical management was 80.4%, meanwhile the postoperative complication rate was 27.2%. The predictive factors significantly associated with success were maternal age < 35years (odds ratio [OR] 4.53, 95% confidence interval [CI] 1.27-16.23; p = 0.02), blood loss before conservative surgery < 1800mL (OR 5.82, 95% CI 1.45-23.33; p = 0.01), and time to start conservative surgery ≤ 40min (OR 4.76, 95% CI 1.13-20.12; p = 0.03). The overall success rate of conservative surgical procedures was high. Maternal age < 35years, blood loss before conservative management < 1800mL, and time to conservative surgery ≤ 40min were predictive factors of success.

EVALUATION OF PERIPARTUM HYSTERECTOMY CASES: EXPERIENCES OF A TERTIARY HEALTH CENTER IN WESTERN REGION OF TURKEY

OBJECTIVE: We aimed to retrospectively examine the cases of peripartum hysterectomy performed in our clinic in the last three years and to evaluate the incidence, risk factors, indications, surgical methods, complications, and results of peripartum hysterectomy.MATERIAL AND METHODS: Patients who had undergone a peripartum hysterectomy in Pamukkale University Medical Faculty Hospital between January 2017 and January 2020 were included in the study. We excluded all patients with the massive peripartum hemorrhage who were treated with conservative approaches (such as suturing or segmental resection of the defective placenta insertion area, uterine compression sutures, intrauterine balloon applications, and uterine or internal iliac artery ligation) rather than hysterectomy. Data of the patients were obtained from patient files and hospital medical records. The demographic and clinical data of the patients were recorded and analyzed.RESULTS: During the three years, a total of 3220 births took place in our hospital. Peripartum hysterectomy was performed in twenty-one patients; the incidence was 6.5/1000. The most common indication for peripartum hysterectomy in the postpartum hemorrhage group was placental location and invasion anomalies (90.4%) and among these anomalies, the most common histopathological diagnosis was the association of placenta previa and placenta increta (33.33%). Massive transfusion, bladder damage, relaparotomy, and wound infection were the major causes of morbidity in patients with peripartum hysterectomy.CONCLUSIONS: Recently, placental location and invasion anomalies have become the most common cause of peripartum hemorrhages. Peripartum hysterectomy is the leading treatment method for patients with abnormal placentation.

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.

Uterine compression sutures as a therapy for massive postpartum hemorrhage: a 5-year report

Uterine compression sutures as a therapy for massive postpartum hemorrhage: a 5-year report

Uterovesical fistula after uterine compression suture

Uterovesical fistula is a rare complication. In this case, a utero-fetal fistula developed in a patient with lower uterine segment compression suture in cesarean section due to placenta previa totalis is described.

Functional Cross Method: A Novel Surgical Approach in the Management of Postpartum Hemorrhage

Postpartum hemorrhage (PPH) remains a significant cause of maternal morbidity worldwide. When medical management of PPH is unsuccessful or contraindicated, surgical options are required. While present uterine compression suture (UCS) techniques can prove effective, the need for hysterectomy remains prevalent. The objective of this study was to determine if a modification on UCS called “Functional Cross Method (FXM)” can improve outcomes for women with PPH.

Hemostatic effect of combined procedures for placenta previa: cervix-holding, intrauterine balloon, and uterine compression suture

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.

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.

Assessing South African medical interns' experience and confidence in managing obstetric emergencies.

Medical doctors in South Africa (SA) are required to complete a 2-year internship at training hospitals, including a 4-month rotation in obstetrics and gynaecology. Following this, doctors are allocated to community service posts, many of which are at district- and primary-level facilities where supervision is limited. Recent triennial Saving Mothers reports identify district hospitals (DHs) as the second leading site for maternal deaths of all causes, the leading site for maternal deaths secondary to obstetric haemorrhage, and the most likely site for the lack of a skilled doctor to be identified as a factor in deaths associated with caesarean delivery. To describe the self-perceived readiness of medical interns completing their training to manage obstetric emergencies, based on the Essential Steps in the Management of Obstetric Emergencies modules in the Health Professions Council of South Africa's internship logbook. This cross-sectional descriptive study assessed medical interns in the last 3 months of their training, using a self-administered online questionnaire. Data collection took place between October and December 2019. Cluster sampling of interns at training facilities throughout SA resulted in a total of 182 respondents from 17 hospitals in seven provinces in the country, with an overall response rate of 34.1%. Most interns had experience with and confidence in the management of miscarriage and hypertension in pregnancy. However, gaps in labour ward management, pregnancy-related sepsis and surgical skills were identified. Only 42.3% of respondents were confident in their ability to diagnose obstructed labour, 26.3% had performed an assisted delivery, 39.0% were confident in their knowledge of the indications for and contraindications to assisted deliveries, and 35.7% had been involved in the delivery of a baby with shoulder dystocia. Regarding pregnancy-related sepsis, 54.4% had experience with managing a wound abscess and 29.7% were confident managing puerperal endometritis. While 78.0% felt confident to perform a caesarean section (CS), only 28.6% had performed uterine compression suture for uterine atony at CS. Additionally, there was a statistically significant variation in scores between training hospitals. An incongruity exists between the shortcomings in DH obstetric services, the prioritisation of placement of community service doctors at primary healthcare facilities and DHs, and the self-perceived readiness of medical interns completing their training to manage obstetric emergencies safely. This situation highlights the importance of clinical support for junior doctors at DHs and standardisation of intern training at accredited facilities across SA.

Alternative suture tightening technique for achieving adequate suture tension during B-Lynch compression suture.

Treatment methods for managing uterine atony include uterine compression sutures such as B-Lynch compression suture [1]. Christopher B-Lynch and colleagues first reported this technique in 1997 [2]. Following this, other types of compression sutures, such as modified B-Lynch, Hayman, Pereira, Ouahba, Hackethal, or Cho suture, have proliferated [3, 4].

Analysis of the Clinical Effect of Bakri Balloon Packing Combined with Zheng Uterine Compression Suture in the Treatment of Postpartum Hemorrhage

Analysis of the Clinical Effect of Bakri Balloon Packing Combined with Zheng Uterine Compression Suture in the Treatment of Postpartum Hemorrhage

A novel low uterine segment sandwich technique (Caliskan's technique) for the management of post-cesarean hemorrhage due to placenta previa accreta

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.

Subsequent pregnancy outcome after uterine compression suture placement for postpartum hemorrhage.

To evaluate the subsequent obstetrical outcome in women who received a uterine compression suture. 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. 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±491.8ml versus 638.8±194ml; P=0.02), and were more likely to need repeat uterine compression suture (6.7% versus 0%; P=0.004). 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.

A novel technique in the management of severe postpartum uterine atony bleeding: Three vertical uterine compression sutures

ObjectivePostpartum 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. DesignTwo 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. ResultsWe 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. ConclusionsTo 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.

A new and feasible uterine compression suture technique in uterine atony to save mothers from postpartum hemorrhage.

Postpartum hemorrhage (PPH) is one of the emergency situations of obstetrics practice that constitutes of 1 to 5% of vaginal and cesarean deliveries. Uterine atony is the number one cause of PPH and is responsible for at least 75% of PPH cases. Uterine compression sutures have been regarded as an effective method in PPH cases, as well as preserving fertility by preserving the uterus. The main purpose of this study was to report on our results with a new uterine compression suture technique that was developed by us. In this study we included all women who needed uterine compression sutures because of uterine atony while cesarean section from January 2014 to December 2018. Fifteen cases with PPH with uterine atony were reported, who were treated with our uterine compression suture technique after conservative medical and uterine massage treatment failure. All of the cases in this study were managed successfully namely none of the patients needed a hysterectomy or reoperation because of bleeding again. One week, one month, three months later all patients were followed up. Six months later 11 patients were examined, four patients lost to follow-up, but they were reached by phone since they were outside of the city, they reported no complaints. Ultrasound examination was performed to follow up patients. Short-term follow-up revealed no complications such as pyometra, endometritis, reoperation, amenorrhea, or uterine necrosis. We described our practice with our uterine compression suture that is easy to learn and apply. All of the cases that participated in our study showed improvement to the compression sutures, so no other surgical interventions were applied. The same suture technique was applied by only one physician. This is a feasible and easy way to stop bleeding in uterine atony and in uterine preservation, especially in rural areas when help may not be available in case of complications.

Removable retropubic uterine compression suture for controlling postpartum hemorrhage

To minimize the adverse events of uterine compression suture in controlling postpartum hemorrhage (PPH) and to search for a prophylactic approach to potential PPH. 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. 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. 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.