Uterine wall partial thickness necrosis following combined B-Lynch and Cho square sutures for the treatment of primary postpartum hemorrhage.
BACKGROUND
Postpartum hemorrhage (PPH) is a significant factor in maternal morbidity and mortality. Successful techniques using compression sutures to control PPH have been described, in some cases using a combination of techniques. We describe a case in which compression sutures to control PPH were complicated by subsequent myometrial necrosis.


METHODS
A healthy 32-year-old woman, gravida 3, para 0, underwent Caesarean section at 41 weeks' gestation after failure to progress in labour. One B-Lynch plus two Cho sutures were used to control postpartum hemorrhage. During a subsequent pregnancy, a large triangular myometrial defect was identified in the mid-anterior uterine wall and two smaller defects in the posterior wall.


CONCLUSIONS
Patients should be informed about the possible complications of the use of compression sutures and the need to undergo postoperative follow-up to confirm uterine wall integrity. We propose the establishment of a national registry of women who undergo placement of compression sutures, in order to document the efficacy and the long-term and short-term complications of this procedure.
Akoury
Hani
H
Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Division, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Sherman
Christopher
C
D000328:Adult; D005260:Female; D006801:Humans; D009336:Necrosis; D006473:Postpartum Hemorrhage / Q000601:surgery*; D011247:Pregnancy; D013536:Suture Techniques / Q000009:adverse effects*; D013537:Sutures / Q000009:adverse effects; D014599:Uterus / Q000473:pathology* / Q000601:surgery*