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Safety and efficiency of multiple square sutures to avoid peripartum hysterectomy

Published:February 16, 2012DOI:https://doi.org/10.1016/j.ajog.2012.02.005
      To the Editors:
      Bateman et al
      • Bateman B.T.
      • Mhyre J.M.
      • Callaghan W.M.
      • Kuklina E.V.
      Peripartum hysterectomy in the United States: nationwide 14 year experience.
      reported an increased rate of hysterectomy for severe postpartum hemorrhage in the United States from 1994-2007. This study is pessimistic and does not reflect the high efficiency of new surgical procedures to stop severe postpartum hemorrhage. Indeed, the first publication on the very high success rate of multiple square sutures to control severe postpartum hemorrhage was in 2000;
      • Cho J.H.
      • Jun H.S.
      • Lee C.N.
      Hemostatic suturing technique for uterine bleeding during cesarean delivery.
      therefore, it is normal that the application of this technique in routine practice and its positive consequences appear many years later. This explains the reason that there is no drop in peripartum hysterectomy rates. Indeed, multiple square sutures are very efficient to control severe postpartum hemorrhage when they are applied correctly.
      • Cho J.H.
      • Jun H.S.
      • Lee C.N.
      Hemostatic suturing technique for uterine bleeding during cesarean delivery.
      • Alouini S.
      • Coly S.
      • Megier P.
      • Lemaire B.
      • Mesnard L.
      • Desroches A.
      Multiple square sutures for postpartum hemorrhage: results and hysteroscopic assessment.
      The rate of success is >90% on uterine atony.
      • Cho J.H.
      • Jun H.S.
      • Lee C.N.
      Hemostatic suturing technique for uterine bleeding during cesarean delivery.
      • Alouini S.
      • Coly S.
      • Megier P.
      • Lemaire B.
      • Mesnard L.
      • Desroches A.
      Multiple square sutures for postpartum hemorrhage: results and hysteroscopic assessment.
      Moreover, fertility is preserved after multiple square sutures, and subsequent pregnancies are possible.
      • Cho J.H.
      • Jun H.S.
      • Lee C.N.
      Hemostatic suturing technique for uterine bleeding during cesarean delivery.
      • Alouini S.
      • Coly S.
      • Megier P.
      • Lemaire B.
      • Mesnard L.
      • Desroches A.
      Multiple square sutures for postpartum hemorrhage: results and hysteroscopic assessment.
      Since 2004, after the introduction of multiple square sutures in our department to control severe hemorrhage, we have observed a drop in hysterectomy rates after uterine atony during cesarean section delivery. Severe postpartum hemorrhage remains difficult to control in cases of placenta accreta or percreta, but rarely in the case of uterine atony, which is the most frequent situation.
      Because severe postpartum hemorrhage that is not controlled by medical treatment is rare, even in big maternity centers, obstetricians should be trained to perform multiple square sutures in emergency situations and on inanimate surgical models to avoid hysterectomy.

      References

        • Bateman B.T.
        • Mhyre J.M.
        • Callaghan W.M.
        • Kuklina E.V.
        Peripartum hysterectomy in the United States: nationwide 14 year experience.
        Am J Obstet Gynecol. 2012; 206: 63.e1-63.e8
        • Cho J.H.
        • Jun H.S.
        • Lee C.N.
        Hemostatic suturing technique for uterine bleeding during cesarean delivery.
        Obstet Gynecol. 2000; 96: 129-131
        • Alouini S.
        • Coly S.
        • Megier P.
        • Lemaire B.
        • Mesnard L.
        • Desroches A.
        Multiple square sutures for postpartum hemorrhage: results and hysteroscopic assessment.
        Am J Obstet Gynecol. 2011; 205: 335.e1-335.e6

      Linked Article

      • Peripartum hysterectomy in the United States: nationwide 14 year experience
        American Journal of Obstetrics & GynecologyVol. 206Issue 1
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          The objective of the study was to examine the trends in the rate of peripartum hysterectomy and the contribution of changes in maternal characteristics to these trends.
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      • Reply
        American Journal of Obstetrics & GynecologyVol. 206Issue 5
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          We appreciate the interest of Drs Alouini and Mesnard in our study. We share the authors' enthusiasm for uterine compression sutures as a treatment of severe postpartum hemorrhage and agree that in many circumstances their use may prevent the need for peripartum hysterectomy.1,2
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