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Published:March 12, 2012DOI:https://doi.org/10.1016/j.ajog.2012.02.039
      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.
      • Baskett T.F.
      Uterine compression sutures for postpartum hemorrhage: efficacy, morbidity, and subsequent pregnancy.
      • Alouini S.
      • Coly S.
      • Megier P.
      • Lemaire B.
      • Mesnard L.
      • Desroches A.
      Multiple square sutures for postpartum hemorrhage: results and hysteroscopic assessment.
      While our study showed a substantial rise in the rate of peripartum hysterectomy in the United States from 1994 through 2007, particularly for uterine atony,
      • Bateman B.T.
      • Mhyre J.M.
      • Callaghan W.M.
      • Kuklina E.V.
      Peripartum hysterectomy in the United States: nationwide 14-year experience.
      we do not interpret this to suggest a lack of efficacy for these techniques. Rather, as the authors suggest, it likely reflects the lack of integration of these approaches into routine clinical practice.
      Our paper should not be read as a pessimistic commentary on efficacy of this approach, but rather as a call to action to disseminate these techniques and encourage their use in appropriate patients.

      References

        • Baskett T.F.
        Uterine compression sutures for postpartum hemorrhage: efficacy, morbidity, and subsequent pregnancy.
        Obstet Gynecol. 2007; 110: 68-71
        • 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
        • 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

      Linked Article

      • Safety and efficiency of multiple square sutures to avoid peripartum hysterectomy
        American Journal of Obstetrics & GynecologyVol. 206Issue 5
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          Bateman et al1 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;2 therefore, it is normal that the application of this technique in routine practice and its positive consequences appear many years later.
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