title: Risk of synechiae following uterine compression sutures in the management of major postpartum haemorrhage.
abstract: OBJECTIVE
  To determine with hysteroscopy or hysterosalpingogram the risk of uterine synechiae following uterine compression sutures for major postpartum haemorrhage (PPH) caused by uterine atony.
  
  
  METHODS
  A retrospective observational study.
  
  
  METHODS
  Department of Obstetrics and Gynaecology, Beaujon Hospital, Clichy, France.
  
  
  METHODS
  One hundred and ninety-seven women with PPH between 2007 and 2010. One hundred and thirteen women (57.4%) were transferred as an emergency to our institution from other centres.
  
  
  METHODS
  Of the 197 women, 94 with PPH had uterine arterial embolisation and 33 with major PPH were managed with surgical uterine compression sutures (Hackethal technique). The women were invited to undergo a control hysteroscopy or hysterosalpingogram, after postpartum consultation, to assess the uterine cavity.
  
  
  METHODS
  The prevalence of subsequent uterine synechiae.
  
  
  RESULTS
  Uterine compression sutures succeeded in controlling PPH in 26 of 33 women (78.8%). Seven needed a hysterectomy. Among women with a preserved uterus, 15 underwent an exploration of the uterine cavity, including hysteroscopy (12) or hysterosalpingogram (8). Four women (26.7%) developed uterine synechiae and one had a subsequent pregnancy 18 months after uterine compression sutures. The median time between delivery and hysteroscopy or hysterosalpingogram was 9.3 months (2.4-34.8 months).
  
  
  CONCLUSIONS
  This study suggests a significant risk of uterine synechiae after placement of compression sutures for PPH that transverse the uterine cavity. Postoperative uterine synechiae might be underestimated, and their prevalence and clinical significance should be assessed in long-term follow-up studies.
authors.affiliation: Department of Obstetrics and Gynecology, Hôpital Beaujon AP-HP, Clichy, France. olivierpoujade@hotmail.com
authors.forename: O
authors.initials: O
authors.lastname: Poujade
authors.forename: A
authors.initials: A
authors.lastname: Grossetti
authors.forename: L
authors.initials: L
authors.lastname: Mougel
authors.forename: P F
authors.initials: PF
authors.lastname: Ceccaldi
authors.forename: G
authors.initials: G
authors.lastname: Ducarme
authors.forename: D
authors.initials: D
authors.lastname: Luton
mesh_terms: D000328:Adult; D005260:Female; D006175:Gynatresia / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D010808:Physical Examination; D006473:Postpartum Hemorrhage / Q000601:surgery*; D011247:Pregnancy; D011312:Pressure; D012189:Retrospective Studies; D012307:Risk Factors; D013536:Suture Techniques / Q000009:adverse effects*; D013537:Sutures / Q000009:adverse effects*; D014593:Uterine Inertia / Q000601:surgery*; D055815:Young Adult