Uterine compression U-sutures in primary postpartum hemorrhage after Cesarean section: fertility preservation with a simple and effective technique.
BACKGROUND
Transmural uterine compression suturing methods are a fertility-preserving alternative in patients with atonic primary postpartum hemorrhage (PPPH), which does not respond to manual compression or drugs. This study evaluated the effectiveness of a modified U-suturing technique in effecting uterine compression in patients with PPPH after Cesarean section.


METHODS
U-suture uterine compression was introduced at our hospital at the beginning of 2005. The medical records of patients with PPPH after Cesarean section who had undergone this treatment, and results of a follow-up and questionnaire were evaluated and our experience with this method was reviewed.


RESULTS
Between January 2005 and September 2007, seven patients underwent uterine compression with U-sutures after PPPH. In all cases, treatment was successful, the hemorrhage was controlled and the uterus preserved. Normal menstruation patterns returned in the five patients who returned the questionnaire and no surgery related morbidities were noted at the follow-up examinations of six patients. The technique was simple to perform in an emergency situation.


CONCLUSIONS
Uterine compression with U-sutures is a highly effective and straightforward emergency procedure which conserves the uterus in these patients.
Hackethal
A
A
Department of Obstetrics and Gynecology, Justus-Liebig-University of Giessen, Klinikstrasse 32, 35385 Giessen, Germany. andreas.hackethal@gyn.med.uni-giessen.de
Brueggmann
D
D
Oehmke
F
F
Tinneberg
H-R
HR
Zygmunt
M T
MT
Muenstedt
K
K
D000328:Adult; D002585:Cesarean Section; D005260:Female; D005298:Fertility; D005500:Follow-Up Studies; D006801:Humans; D011184:Postoperative Period; D006473:Postpartum Hemorrhage / Q000601:surgery*; D011247:Pregnancy; D013536:Suture Techniques; D016896:Treatment Outcome; D014599:Uterus / Q000601:surgery*