title: Application of uterine compression suture in association with intrauterine balloon tamponade ('uterine sandwich') for postpartum hemorrhage.
abstract: We evaluated in a prospective observational study the use of a 'uterine sandwich' technique (uterine compression sutures in association with intrauterine tamponade) in women who had had unsuccessful medical treatment for postpartum hemorrhage. Ten of the 11 patients had cesarean sections (complicated by placenta previa and uterine atony) and one had a normal delivery. The median estimated blood loss and units of blood transfused were 1500ml (range 750-4000ml) and two units (range 0-9), respectively. B-Lynch sutures were placed in two patients and Hayman's modification was used in nine. Bakri balloon tamponade was in place for a median of 22 hours (range 17-27 hours), while the median volume infused in the balloon was 300ml (range 150-350ml). The combined technique was successful in avoiding hysterectomy in all cases, and there was no documented postpartum morbidity. This is a simple and quick surgical technique that can be used to treat atonic postpartum hemorrhage, particularly in conjunction with placenta previa.
authors.affiliation: Department of Obstetrics and Gynecology, North Middlesex University Hospital.
authors.forename: Wai
authors.initials: W
authors.lastname: Yoong
authors.affiliation: University College London Medical School, London, UK.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Ridout
authors.affiliation: Department of Obstetrics and Gynecology, North Middlesex University Hospital.
authors.forename: Maria
authors.initials: M
authors.lastname: Memtsa
authors.affiliation: Department of Obstetrics and Gynecology, North Middlesex University Hospital.
authors.forename: Andreas
authors.initials: A
authors.lastname: Stavroulis
authors.affiliation: Department of Obstetrics and Gynecology, North Middlesex University Hospital.
authors.forename: Mernoosh
authors.initials: M
authors.lastname: Aref-Adib
authors.affiliation: Department of Obstetrics and Gynecology, North Middlesex University Hospital.
authors.forename: Zeudi
authors.initials: Z
authors.lastname: Ramsay-Marcelle
authors.affiliation: Department of Obstetrics and Gynecology, North Middlesex University Hospital.
authors.forename: Abiodun
authors.initials: A
authors.lastname: Fakokunde
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D010923:Placenta Previa; D006473:Postpartum Hemorrhage / Q000209:etiology / Q000628:therapy*; D011247:Pregnancy; D011446:Prospective Studies; D013536:Suture Techniques / Q000295:instrumentation; D013537:Sutures; D016896:Treatment Outcome; D058738:Uterine Balloon Tamponade / Q000295:instrumentation / Q000379:methods*; D014593:Uterine Inertia; D055815:Young Adult