Uterine preservation with Cho suture in localized multifocal atonicity of uterus with failed medical management and uterine tamponade

Postpartum haemorrhage (PPH) is a major cause of maternal morbidity and mortality, and one of the common obstetrical emergencies. Quite commonly, it occurs in patients where PPH is not expected. Management has to be swift and precise according to the steps and the response initiated by the uterine musculature during the management. In our patient, we had a localized multifocal atony of the uterus, at points where the uterine sinuses were bleeding due to atony, and medical management and uterine tamponade failed, with a raised D-dimer level. As the stepwise management failed with uterine devascularisation failing to control PPH, a decision for uterine compression suture (UCS), Cho suture was taken.

Uterine Compression Suture Versus Cesarean Hysterectomy in Management of Intractable Postpartum Hemorrhage

Background: Postpartum hemorrhage (PPH) is the third leading cause of maternal death. Uterine atony is the most common cause, and surgical management is the last method for PPH. Objective: To assess operative outcomes after uterine compression suture (B-Lynch suture technique) versus cesarean hysterectomy. Materials and Methods: The comparison retrospective research evaluated the operative outcomes of the pregnant women managed by the B-Lynch suture technique (group 1) versus cesarean hysterectomy (group 2). Unique data form, designed to collect all patients involved in the present study, were reviewed and analyzed. The population study was pregnant women divided into two groups. Thirty-five patients were assigned to group 1 and thirty-five patients were assigned to group 2. The independent t-test was used to compare means of categorical variables between the two groups, with p<0.05 indicating statistical significance. Results: Twenty-three thousand two hundred fifty-eight pregnant women delivered during the study period, which was 18 years 6 months. PPH occurred in 563 patients (2.42%), in both vaginal and cesarean deliveries. Intractable PPH occurred in 177 patients (0.76%) during cesarean section. Clinical data risk factors were age, complications while receiving blood transfusion, injury to the urinary bladder, and death. Several outcomes in group 1 were better than in group 2, such as the interval of operation, blood loss, fever after surgery, and saving of life. However, three patients in the trial of B-Lynch suture were changed to hysterectomy due to curative management. Conclusion: The uterine compression suture (the B-Lynch technique) should be used promptly to manage acute PPH due to uterine atony. Additionally, a cesarean hysterectomy might be used for surgical management in the latter method, depending on the severity of the patient, the etiology of PPH, and the obstetrician’s skills and experience. Keywords: Postpartum hemorrhage, Uterine compression suture, Cesarean hysterectomy