Uterine Compression Research Articles

Surgical hemostasis for obstetric hemorrhage: experimental and clinical studies

The article presents a review of the literature on the problems of treatment of obstetric bleeding in the light of historical development and modern opportunities. Currently existing options for surgical hemostasis: ligation of pelvic vessels, ligation of internal iliac arteries, embolization of uterine arteries and compression sutures on the uterus are considered from the perspective of experimental work and clinical research. The paper reflects the opinions of domestic and foreign scientists, which were a vector for further study and experiments.

Ischemic uterine necrosis following Hayman suture for postpartum hemorrhage.

Awareness of grave complications like ischemic necrosis associated with uterine compression sutures is essential for prompt diagnosis and timely management.

Carbetocin versus Misoprostol in Reducing Blood Loss during Cesarean Section in low risk patients. A Randomized Controlled Trial

Aim: This study aimed to compare the use of misoprostol to carbetocin in reducing blood loss during cesarean section in low risk patients.Materials and Methods: This randomized controlled study enrolled 300 patients who were eligible. 150 women received carbetocin100ug i.v intra-operative immediately after extraction of the fetus during cesarean section (group A). They were compared to 150 women who received misoprostol 600ug rectally immediately before sterilization during caesarean section (group B).Results: There is significant difference in intraoperative uterine atony [3 (2.0%) vs 11 (7.3%) P 0.018] and surgical hemostatic measures as uterine artery ligation and uterine compression sutures [0.00 vs 3.00 (2%) P < 0.00 and 0.00 vs 12.00 (8%) P < 0.00] were higher in misopristol group. Also, the need for other uterotonic drugs was significantly higher in misopristol group (10.0 ± 0.0 vs 13.15 ± 5.28, P < 0.001 and the difference in hemoglobin and hematocrit values before and after delivery were slightly higher in misopristol group with no statistical significance (10.71 ± 0.98 vs 10.86 ± 0.84, P < 0.15 and 33.86 ± 2.8 vs 34.29 ± 2.7, P < 0.17).Conclusion: Intravenous therapy infusion of 100 ug carbetocin reduced but no significantly blood loss during cesarean section than 600ug rectal misoprostol.

Comparison of Outcome Between Intrauterine Balloon Tamponade and Uterine Artery Embolization in the Management of Persistent Postpartum Hemorrhage: A Propensity Score–matched Cohort Study

(Acta Obstet Gynecol Scand. 2019;98:1473–1482) Peripartum hysterectomy can be life-saving in the setting of postpartum hemorrhage (PPH). However, it produces infertility and is therefore considered a treatment of last resort. Many other procedures are first attempted to control PPH in an effort to avoid peripartum hysterectomy, such as intrauterine balloon tamponade, uterine compression sutures, and uterine artery ligation or embolization. Uterine artery embolization and intrauterine balloon tamponade have not previously been compared in terms of their effectiveness in preventing maternal death or near miss in women experiencing PPH. Uterine artery embolization is costly and may lead to thromboembolic events and other complications. Intrauterine balloon tamponade has more recently emerged as a more inexpensive strategy for managing PPH. This study aimed to compare the effectiveness of these 2 techniques for the management of persistent PPH.

Uterine compression sutures with additional hemostatic procedures for the management of postpartum hemorrhage.

The aim of the study was to evaluate the efficacies and possible short-term complications in women receiving uterine compression sutures only and those with additional hemostatic procedures for the management of postpartum hemorrhage. It was a retrospective study carried out from year 2009 to 2019 at a tertiary obstetric hospital and included 79 women who underwent uterine compression sutures (B-Lynch sutures, Hayman's sutures and Cho's sutures) for primary postpartum hemorrhage. Thirty-six of these women had additional hemostatic procedures (uterine artery ligation or embolization) performed for bleeding control. Of the 43 women who were primarily treated with uterine compression sutures only, the success rate to preserve the uterus was 97.7% (42/43). In women with uterine compression sutures and additional hemostatic procedures performed, the success rate was 75% (27/36). Among these two groups of women without peripartum hysterectomy, there were no significant differences in the incidence of secondary postpartum hemorrhage (14.8% vs. 11.9%; P = 0.729), postoperative endometritis (14.8% vs. 14.3%; P > 0.99) and retained products of conception (3.7% vs. 9.5%; P = 0.641) during their 6-week postpartum checkup. Three women were diagnosed to have hematometra. No pyometra or uterine necrosis was noted. Uterine compression sutures with additional hemostatic procedures are effective to control postpartum hemorrhage and prevent hysterectomy. The short-term complication rate is low. Long-term monitoring is needed to identify rare but potentially dangerous complications.

A Uterus-Preserving Treatment for Uncontrollable Postpartum Hemorrhage: Esike's Technique.

Postpartum hemorrhage is a leading cause of maternal morbidity and mortality worldwide, with uterine atony responsible in 80% of cases. In intractable cases, hysterectomy is the final treatment, but it has complications. Many doctors in developing countries with high maternal mortality rates from postpartum hemorrhage can perform cesarean deliveries but cannot perform hysterectomy. Patients with postpartum hemorrhage who need hysterectomy in these countries will die in such cases, whereas, if doctors know this simple, easily learned technique, such patients may survive. Esike's technique is a uterine-compression method that uses supplies generally available at delivery hospitals. Six sutures are placed in the lower uterine segment, three anteriorly and three posteriorly. Starting with the middle sutures, the sutures are tied at the fundus with the help of an assistant to provide uterine compression. The more laterally placed sutures are then tied similarly, resulting in uterine compression and stoppage of postpartum hemorrhage. Esike's technique was used in controlling life-threatening, uncontrollable postpartum hemorrhage in 18 women and was successful in 16 (89%) without requiring hysterectomy. Esike's technique is effective in controlling life-threatening postpartum hemorrhage and can be used in low-resource settings with commonly available supplies and performed by doctors with a common level of training.

Maternal Fetal Health

Maternal Fetal Health

Mechanical and surgical interventions for treating primary postpartum haemorrhage.

Mechanical and surgical interventions for treating primary postpartum haemorrhage.

A prospective study of B-Lynch suture in the management of atonic PPH at tertiary care centre

Postpartum haemorrhage (PPH) is one of the leading causes of maternal mortality and morbidity especially in the developing countries like India. Uterine compression sutures, originally described by B-Lynch et al can successfully control life-threatening PPH. With this background, we studied the use of modified B-Lynch sutures in our setup.It was a single centre, hospital based cross sectional study conducted in the department of obstetrics and gynaecology in a tertiary care hospital in Maharashtra. About 50 cases during the study period (Nov 2017 to June 2019) who failed the medical management of control of PPH were included in the study. Demographic details like age, gestational age, religion, socio economic status and gravid were noted in the case record form. Amount of blood loss, success rates, immediate complications and follow up fertility were assessed.Among the 50 study subjects, 24% had blood loss of &amp;#60;1000ml, 54% had loss between 1000 to 1500ml, 16% had loss of 1501 to 2000ml and 6% had loss more than 2000ml in the present study. About 80% of the cases were successful and 20% failed in the present study. About 6% of the cases had wound gaping, 12% each had fever and had hospital stay more than 5 days and 14% of the cases had wound infection in the present study. About 90% of the cases had return of regular menstruation in the present study.The success rate of B Lynch suture was 80% in the present study. There were few post operative immediate complications in our study. Follow up data also suggested that majority of them recovered with normal routine. In our experience, the B-Lynch technique is a safe, effective and easily implemented method of arresting bleeding in cases of major primary PPH due to uterine atony.

Nécrose utérine suite à une combinaison de compressions utérines et de ligature vasculaire lors d'une hémorragie post-partum: rapport de cas

L'hémorragie de délivrance reste la première cause de mortalité maternelle au Maroc, c´est une urgence obstétricale qui nécessite une prise en charge rapide, efficace et multidisciplinaire. Dans les cas d´hémorragie du post-partum grave rebelle au traitement médical, les progrès de la radiologie interventionnelle et surtout des techniques chirurgicales ont fourni des alternatives sûres et efficaces à l'hystérectomie d´hémostase. On rapporte un cas de nécrose utérine suite à un traitement conservateur chirurgicale de l´hémorragie de délivrance à base d´une combinaison de technique de compression utérine type B-Lynch et triple ligature vasculaire de Tsirulnikov. La patiente a présenté un tableau de sepsis a J4 du post-partum avec un état fébrile et des douleurs pelviennes et un syndrome inflammatoire biologique qui s´est aggravé 48 heures après par l´apparition de contracture abdominale. Le scanner abdomino-pelvien a montré des bulles de gaz dans le myomètre utérin évoquant une nécrose. Une laparotomie exploratoire a été réalisée, l'exploration a révélé une nécrose complète de l'utérus. Les techniques chirurgicales des sutures de compression utérine jouent un rôle majeur dans l'arsenal thérapeutique de l'hémorragie post-partum pendant la césarienne. Elle permet, en complément ou en alternative à la ligature vasculaire, la préservation de la fertilité de la patiente mais elle nécessite également une prudence et une surveillance maximale des complications dont la plus grave est la nécrose utérine.

592: Autonomic and cerebral response to umbilical cord occlusions with worsening acidosis in the fetal sheep

Labor is a situation at risk of fetal hypoxia due to uterine contractions and/or compression of the umbilical. It could lead to fetal brain injury and hypoxic-ischemic encephalopathy (HIE). The autonomic nervous system (ANS) is a key mediator of fetal homeostasis, and its activity can be measured with heart rate variability (HRV) analysis. The objective of this experimental study in a fetal sheep model, was to evaluate HRV variation and cerebral injury. Repeated 1-minute umbilical cord occlusions (UCO) were performed at a mild (phase A, 1UCO/5mn)), moderate (phase B, 1 UCO/3mn), and severe (phase C, 1UCO/2mn) period until arterial pH reached 6.90. Hemodynamic, blood gas analysis, S100B and Troponin T assessment, and HRVwere recorded at specific time points. S100B is a protein linked with cerebral injury. ANS activity was evaluated though a new index developed by our team, the Fetal Stress Index (FSI), which was correlated in previous studies with parasympathetic activity and acidosis. Ten experiments were performed. UCOs resulted in progressive severe fetal acidosis with pH dropping to 6.99 0.13. FSI increased with acidosis: 57.7 8.6 during phase A vs 71.9 11.4 during phase C (p=0.032). Fetal S100B also increased throughout UCO series with a rise of 7% 4 during phase A compared to initial value, and 24% 8 during phase C (p< 0.001). FSI was correlated with pH (r=-0.529, p=0.003) and fetal S100B variation (r=0.583, p= 0.002). The main objective of fetal monitoring during labor is to prevent HIE. In this study, we observed that HRV analysis could predict cerebral injury and be a future marker of fetal well-being during labor.

Conservative surgical management for immediate postpartum hemorrhage

Abstract Background Conservative surgical management for postpartum hemorrhage (PPH), such as balloon tamponade, uterine compression suture, and uterine artery ligation, has the benefit of preserving reproductive function. Objectives To assess the efficacy and subsequent pregnancy outcome of conservative surgical management for patients with immediate PPH. Methods Medical records of patients who had PPH between January 2011 and December 2016 were reviewed. Conservative surgical management included B-Lynch uterine compression suture, Bakri balloon tamponade, and uterine artery ligation. The treatments were considered successful if patients did not require subsequent hysterectomy. Perioperative complications and subsequent pregnancy outcomes were recorded. Results Of 30,271 deliveries, 669 patients experienced PPH or 2.2% of total deliveries. Sixty-one patients (9.1%) did not respond to medical treatment with various uterotonic agents. Hysterectomy was selected initially in 30 patients. Conservative surgical management was performed in 31 patients: 15 Bakri balloon tamponade, 13 uterine compression suture, and 3 uterine artery ligation. There were 3 patients who failed Bakri balloon tamponade and proceeded to perform uterine compression suture with successful outcome. The success rates for conservative surgical treatment were 66.7%, 75%, and 66.7%, respectively. All patients who had successful conservative surgical management resumed normal menstruation. Three out of 11 patients (27.3%) who desired subsequent pregnancy were able to conceive and carry out a viable pregnancy. Conclusion Conservative surgical management has acceptable success rates for controlling intractable immediate PPH. Implementation of such procedures should be done to preserve fertility and decrease maternal morbidity and mortality.

Prophylactic uterine compression sutures for addressing potential postpartum hemorrhage

Prophylactic uterine compression sutures for addressing potential postpartum hemorrhage

Postpartum hemorrhage care bundles to improve adherence to guidelines: A WHO technical consultation.

ObjectiveTo systematically develop evidence‐based bundles for care of postpartum hemorrhage (PPH).MethodsAn international technical consultation was conducted in 2017 to develop draft bundles of clinical interventions for PPH taken from the WHO's 2012 and 2017 PPH recommendations and based on the validated “GRADE Evidence‐to‐Decision” framework. Twenty‐three global maternal‐health experts participated in the development process, which was informed by a systematic literature search on bundle definitions, designs, and implementation experiences. Over a 6‐month period, the expert panel met online and via teleconferences, culminating in a 2‐day in‐person meeting.ResultsThe consultation led to the definition of two care bundles for facility implementation. The “first response to PPH bundle” comprises uterotonics, isotonic crystalloids, tranexamic acid, and uterine massage. The “response to refractory PPH bundle” comprises compressive measures (aortic or bimanual uterine compression), the non‐pneumatic antishock garment, and intrauterine balloon tamponade (IBT). Advocacy, training, teamwork, communication, and use of best clinical practices were defined as PPH bundle supporting elements.ConclusionFor the first response bundle, further research should assess its feasibility, acceptability, and effectiveness; and identify optimal implementation strategies. For the response to refractory bundle, further research should address pending controversies, including the operational definition of refractory PPH and effectiveness of IBT devices.

Uterine compression suture is an effective mode of treatment of postpartum haemorrhage.

Objective:To compare the effects of uterine compression suture versus conventional mode of treatment for the management of postpartum haemorrhage after caesarean section.Methods:This study enrolled 84 women with postpartum hemorrhage who were admitted to Binzhou People’s Hospital from August 2017 to October 2018 as the research subjects. They were divided into a control group and an observation group according to random number table method, 42 each group. The patients in the control group were treated by conventional treatment, while those in the observation group were treated by uterine compression suture. The hemorrhage, hemostasis, postoperative recovery and frequency of adverse reactions were compared between the two groups.Results:The amount of bleeding in the observation group was less than that in the control group, and the bleeding time was shorter than that in the control group; the differences had statistical significance (P<0.05). The success rate of hemostasis in the observation group was significantly higher than that in the control group, and the ineffective rate of hemostasis was significantly lower than that in the control group (P<0.05); the differences were statistically significant. The cleaning time of lochia, the recovery time of uterus and the recovery time of menstruation in the observation group were significantly shorter than that in the control group (P<0.05); the differences between the two groups were statistically significant (P<0.05). The frequency of adverse reactions in the observation group was significantly lower than that in the control group (P<0.05), and the difference was statistically significant (P<0.05).Conclusion:Uterine compression suture is effective for postpartum hemorrhage of cesarean section, which can effectively reduce postpartum hemorrhage, shorten postpartum hemorrhage time and accelerate the recovery. It is safe and worth clinical promotion.

Systematic review on the needle and suture types for uterine compression sutures: a literature review

BackgroundThis study aimed to identify and review associations between the types of sutures used for uterine compression suture (UCS) and its outcomes in postpartum hemorrhage.MethodsAn electronic search using PubMed and Scopus databases was performed. We included the English articles reported from January 1, 1997, to May 31, 2017, using search words or terms regarding the types of suture and needle used for UCSs. We only included studies describing the sutures in the systematic review.ResultsWe found 196 studies and included 76 (38.8%) in our analysis. We collected data on maternal outcomes for 924 patients and categorized them. Of the 76 studies, suture sizes 0, 1, and 2 were used in 6, 44, and 32 articles, respectively (some studies used multiple sutures). Of the 45 studies mentioning the needles, curved and straight needles were used in 35 and 10, respectively. The results of our review revealed that about 80% of previous articles used Catgut and Polyglactin 910 sutures. Because no studies that compared the efficacy of different size of sutures were identified, we investigated the differences using the cases reported in previous studies mentioned above. In the first analysis, we compared the uterine preservation rate between size 1 and size 2 sutures. We found no significant difference in uterine preservation rate (92.8%: size 1 vs. 94.2%: size 2, p > 0.05) but found significant difference in transfusion rate (62.4% vs. 79.1%, p < 0.01). With the hypothesis that non-transfusion cases were less severe, we excluded these cases from second analysis. Although our second analysis of only Catgut or Polyglactin showed strong selection bias, we observed that uterine preservation rate was significantly higher in cases with size 2 suture than in those with size 1 suture (86.9% vs. 93.5%, p = 0.033).ConclusionsOur systematic review showed that approximately 80% of cases were treated by Catgut and Polyglactin 910. Due to the heterogeneity of cases included in this review, it is difficult to estimate which suture is better for UCSs. More robust studies are necessary to enable the identification of the superior suture for performing UCSs.

Training for the surgical management of postpartum hemorrhage: a multicenter survey of resident physicians

Background To actively address maternal morbidity and mortality in Mexico, proficiency among obstetrics and gynecology (OBGYN) residents in the surgical management of postpartum hemorrhage (PPH) is a priority. However, the capacity of programs to provide this training is unknown. Objective The self-reported knowledge, education, and proficiency of common surgical techniques for the management of PPH among OBGYN residents in Mexico was evaluated. Educational resources, perceived barriers to acquiring skills, and clinical decision-making were explored. Materials and methods In July of 2018, an anonymous electronic survey was sent to 86 residents at four hospitals throughout Mexico. Surgical techniques queried included uterine tamponade (UT), uterine compression sutures (UCS), uterine devascularization (UD), hypogastric artery ligation (HAL), and gravid hysterectomy (HT). Participants also answered case-based questions about a patient with PPH. Results The survey response rate was 59.3% (51/86). Seventy-nine percent of residents reported understanding the rationale and techniques for the surgical intervention of PPH. However, 43.9% reported limited ability to perform these procedures with autonomy. Eighty-six percent of residents reported exposure to these techniques while performing a rescue procedure during PPH and 49% reported learning these procedures while performing prophylactic techniques in patients without PPH. Only 25.5% had been exposed to simulation training. Lack of a training module for these skills in their curriculum was noted by 74.5%. The majority of the participants chose UCS, UD, HAL, and HT as the first, second, third, and fourth rescue procedures to perform for PPH, respectively. Conclusion Most residents reported theoretical knowledge of surgical interventions for PPH, but their self-rated ability to independently perform such skills and a curriculum focused on PPH management was suboptimal.

Efficacy of the dedicated needle for uterine compression suture and Bakri balloon for postpartum hemorrhage with placenta previa

Efficacy of the dedicated needle for uterine compression suture and Bakri balloon for postpartum hemorrhage with placenta previa

Rotura uterina en el segundo trimestre por acretismo placentario, en gestante con sutura compresiva uterina previa

La hemorragia posparto puede ser una afección potencialmente mortal. Se han descrito técnicas exitosas que utilizan suturas de compresión uterina para controlar la hemorragia postparto, en algunos casos utilizando una combinación de técnicas. Los procedimientos para reducir la pérdida sanguínea varían desde masaje uterino, tratamiento médico, taponamiento uterino e histerectomía. La sutura compresiva uterina, o técnica de B-Lynch, se ha propuesto para controlar la hemorragia posparto en aquellos casos de atonía uterina, preservando la fertilidad. Aunque el reporte de complicaciones de este procedimiento es escaso, se ha descrito la aparición de necrosis, piometra, rotura uterina y, más recientemente, invasión exagerada y anormal de la placenta (acretismo placentario) en el embarazo subsiguiente. En necesario informar a las pacientes sobre las complicaciones potenciales del procedimiento y la necesidad de seguimiento postoperatorio para confirmar la ausencia de complicaciones. Se presenta un caso de rotura uterina en el segundo trimestre por acretismo placentario en gestante con sutura compresiva uterina previa.

Surgical treatment of postpartum haemorrhage: national survey of French residents of obstetrics and gynecology

BackgroundPostpartum haemorrhage (PPH) is a major cause of maternal morbidity and one of the leading causes of maternal mortality worldwide. Many medical treatments and interventions are available nowadays, but surgical treatment is sometimes required when less invasive methods are unsuccessful. This study aimed to assess the theoretical and practical knowledge of French residents of Obstetrics and Gynecology concerning the surgical treatment of postpartum haemorrhage.Study designWe performed a questionnaire study for senior residents of Obstetrics and Gynecology in France (fourth and fifth year of training). An anonymous survey was sent by email. Between December 2013 and April 2014, a total of 370 residents responded.ResultThe response rate was 47.6% (176/370). Only 156 questionnaires were fully completed and included for analysis. In all, 74% (115/156) of residents reported not mastering sufficiently or at all the technique for bilateral ligation of uterine arteries, 79% (123/156) for uterine compression sutures, 95% (148/156) for ligation of the internal iliac arteries, and 78% (122/156) for emergency peripartum hysterectomy. More than half of respondents (55%, 86/156) stated that they had not mastered any of these techniques.ConclusionAn alarmingly high number of French senior residents in Obstetrics and Gynecology report that they have not acquired the sufficient surgical skills during their training to be able to perform the surgeries required for the management of PPH.