OTTAWA — Uterine compression sutures were an effective and relatively easy treatment for hemorrhage following cesarean section in a series of 28 women at one Canadian hospital.
Placement of compression sutures avoided the need for a hysterectomy in 23 of the 28 patients, and seven of the women treated with a uterine compression suture subsequently had uncomplicated, term pregnancies with cesarean delivery, Thomas F. Baskett, M.B., reported in a poster at the annual clinical meeting of the Society of Obstetricians and Gynaecologists of Canada. During 2000–2006, 31,519 deliveries occurred at Dalhousie University in Halifax, N.S. During this period, compression sutures for postpartum uterine hemorrhage were used an average of about once every 1,126 deliveries. All of these were cesarean sections. The rate of suturing for cesareans done during labor was 22 in 4,870 surgeries, a rate of once in every 221 emergency cesareans. The remaining six compression sutures were placed following an elective surgical delivery, a rate of once in every 637 cesareans, Dr. Baskett reported in his poster.
The indications for uterine suturing were atonic postpartum hemorrhage in 25 women, placenta previa in two patients, and partial placenta accreta in one patient. Thirteen of the women also required a blood transfusion, and five received intensive care. Four patients required ligation of their uterine/ovarian artery. Among the 22 women who were in labor at the time of surgery, eight developed postoperative endomyometritis.
In the 25 women with uterine atony, 20 had prolonged labor and dystocia. Many of these 20 women also had associated chorioamnionitis. The exhausted and infected uterus in these patients might not respond to uterotonic drugs, said Dr. Baskett, a professor of ob.gyn. at Dalhousie University. The most common type of suture used was a B-Lynch in 16. Six women received a B-Lynch and square suture, and four got a B-Lynch and vertical suture.