Aim: To assess the efficacy of a uterine compression suture technique in controlling hemorrhage after removal of complete placenta previa during cesarean section. Methods: This prospective study was performed in a tertiary referral hospital and included 18 patients with postpartum hemorrhage following removal of complete placenta previa during elective cesarean section. All 18 patients underwent bilateral anteroposterior compression suture of the lower uterine segment. All patients were followed postpartum for evaluation of uterine cavity and menstrual cycles. Results: Anteroposterior compressive suture of the lower uterine segment achieved immediate complete hemostasis in all 18 patients. No surgical complication was observed. All patients recovered normal menstrual cycles. Normal patency of the uterine cavity was documented with sonohysterography in all patients at the 6-month follow-up visit. Conclusions: This quick and simple suture technique seems to be effective in stopping hemorrhage following complete placenta previa removal during cesarean section. Normal patency of the uterine cavity seems not to be impaired at medium-term follow-up.

Keywords:
Placenta previa, Postpartum hemorrhage, Uterine compression sutures
1.
Rogers J, Wood J, McCandlish R, Ayers S,Truesdale A, Elbourne D: Active versus expectant management of third stage of labour: the Hichinngbrooke randomized controlled trial. Lancet 1998;351:693–699.
2.
World Health Organization: Attending to 136 Million Births, Every Year: Make Every Mother and Child Count: The World Report 2005. Geneva, WHO, 2005, pp 62–63.
3.
Doumouchtsis SK, Papageorghiou AT, Arulkumaran S: Systematic review of conservative management of postpartum hemorrhage: what to do when medical treatment fails. Obstet Gynecol Surv 2007;62:540–547.
4.
ACOG Practice Bulletin: Clinical management guidelines for Obstetricians-Gynecologists. Obstet Gynecol 2006;108:1039–1047
5.
Senthiles L, Gromez A, Razzouk K, Resch B, Verspyck E, Marpeau L: B-Lynch suture for massive persistent postpartum hemorrhage following stepwise uterine devascularization. Acta Obstet Gynecol 2008;87:1020–1026.
6.
Ying H, Duan T, Bao Y-R, Song Y-H, Wang D-F: Transverse annular compression sutures in the lower uterine segment to control postpartum hemorrhage at cesarean delivery for complete placenta previa. Int J Gynecol Obstet 2010;108:247–289.
7.
Abd Rabbo, Senthiles L, Descamps P: Which surgery should be the first-line uterine sparing procedure to control severe postpartum hemorrhage? Fertil Steril 2011;95:e71.
8.
Kajemg, Kurinczu JJ, Alfirevic Z, Spark P, Brocklehurst P, Knight M: Uterine compression sutures for the management of severe postpartum hemorrhage. Obstet Gynecol 2011;117:14–20.
9.
Clark Al, Phelan JP, Yeh SY, Bruce SR, Paul RH: Hypogastric artery ligation for obstetric hemorrhage. Obstet Gynecol 1985;66:353–356.
10.
Senthiles L, Gromez A, Descamps P, Marpeau L: Why stepwise uterine devascularization should be the first-line conservative surgical treatment to control severe postpartum hemorrhage? Acta Obstet Gynecol Scand 2009;88:490–492.
11.
Senthiles L, Trichot C, Resch B, Sergent F, Roman H, Marpeau L, Verspyck E: Fertility and pregnancy outcomes following uterine devascularization for severe postpartum haemorrhage. Hum Reprod 2008;23:1087–1092.
12.
B-Lynch C, Coker A, Lawal AH, Abu J, Cowen MJ: The B-Lynch surgical technique for the control of massive postpartum haemorrhage: an alternative to hysterectomy? Five cases reported. Br J Obstet Gynaecol 1997;104:372–375.
13.
Hayman RG, Arulkumaran S, Steer PJ: Uterine compression sutures: surgical management of postpartum hemorrhage. Obstet Gynecol 2002;99:502–506.
14.
Faiz AS, Ananth CV: Etiology and risk factors for placenta previa: an overview and meta-analysis of observational studies. J Matern Fetal Neonatal Med 2003;13:175–190.
15.
Olive EC, Roberts CL, Algert CS, Morris JM: Placenta previa: maternal morbidity and place of birth. Aust NZ J Obstet Gynaecol 2005;45:499–504.
16.
Tuzovic L: Complete versus incomplete placenta previa and obstetric outcome. Int J Gynecol Obstet 2006;93:110–117.
17.
Zaideh SM, Abu-Heija AT, El-Jallad MF: Placenta previa and accreta: analysis of a two-year experience. Gynecol Obstet Invest 1988;46:96–98.
18.
Nielsen T, Hagberg H, Ljungblad U: Placenta previa and antepartum hemorrhage after previous cesarean section. Gynecol Obstet Invest 1989;27:88–90.
19.
Clark S, Koonings P, Phelan J: Placenta previa/accreta and prior cesarean section. Obstet Gynecol 1985;66:89–92.
20.
Romundstad LB, Romundstad PR, Sunde A, von During V, Skjaerven R, Vatten LJ: Increased risk of placenta previa in pregnancies following IVF/ICSI; a comparison of ART and non-ART pregnancies in the same mother. Hum Reprod 2006;21:20353–20358.
21.
Healy DL, Breheny S, Halliday J, Jaques A, Rushford D, Garrett C, Talbot JM, Baker HW: Prevalence and risk factors for obstetric haemorrhage in 6730 singleton births after assisted reproductive technology in Victoria Australia. Hum Reprod 2010;25:265–274.
22.
Ghezzi F, Cromi A, Uccella S, Raio L, Bolis P, Surbek D: The Hayman technique: a simple method to treat postpartum haemorrhage. BJOG 2007;114:362–365.
23.
Baskett TF: Uterine compression sutures for postpartum hemorrhage. Obstet Gynecol 2007;110:68–71.
24.
Price N, B-Lynch C: Technical description of B-Lynch suture for treatment of massive postpartum hemorrhage and review of published cases. Int J Fertil 2005;50:148–163.
25.
Wohlmuth CT, Gumbs J, Quebral-Ivie J: B-Lynch suture: a case series. Int J Fertil Women Med 2005;50:167–173.
26.
Allahdin S, Aird C, Danielian P: B-Lynch sutures for major primary postpartum haemorrhage at caesarean section. J Obstet Gynecol 2006;26:639–642.
27.
Sentilhes L, Gromez A, Trichot C, Richbourg-Schneider A, Descamps P, Marpeau L: Fertility after B-Lynch suture and stepwise uterine devascularization. Fertil Steril 2009;91:934.e5–e9.
28.
Cunningham FG, MacDonald PC, Leveno KJ, Gant NF, Gilstrap LC: Anatomy of the reproductive tract of women; in: Williams’ Obstetrics. Norwalk, Appleton Lange, 1993, pp 57–81.
29.
Hwu YM, Chen CP, Chen HS, Su TH: Parallel vertical compression sutures: a technique to control bleeding from placenta praevia or accreta during caesarean section. Br J Obstet Gynaecol 2005;112:1420–1423.
30.
Cho JH, Jun HS, Lee CN: Hemostatic suturing technique for uterine bleeding during cesarean delivery. Obstet Gynecol 2000;96:129–131.
31.
Ochoa M, Allaire AD, Stitely ML: Pyometra after hemostatic square suture technique. Obstet Gynecol 2002;99:506–509.
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2012
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