title: Multiple square sutures for postpartum hemorrhage: results and hysteroscopic assessment.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the efficiency and morbidity of multiple square sutures in severe postpartum hemorrhage.
  
  
  METHODS
  A retrospective study encompassed 30 multiple square sutures that were performed for severe postpartum hemorrhage in 26,605 deliveries in a tertiary maternity center. The main outcome measures were the ability to stop hemorrhage and the assessment of the uterine cavity by hysteroscopy at 3 months.
  
  
  RESULTS
  Multiple square sutures stopped postpartum hemorrhage in 28 of 30 cases (93%). Twenty women underwent hysteroscopy after multiple square sutures. Eight women (40%) did not have intrauterine adhesions. Nine women (45%) had thin and localized intrauterine adhesions that were removed easily by the tip of the hysteroscope; 2 women had moderate intrauterine adhesions that were resected. One patient had endometritis followed by severe intrauterine adhesions.
  
  
  CONCLUSIONS
  Multiple square sutures are effective and safe for the control of severe postpartum hemorrhage and for uterine conservation in most cases. Although some patients had moderate or severe adhesions, a normal uterine cavity or minimal intrauterine adhesions that were removed easily were the most frequent findings at hysteroscopy. A prospective study may be helpful to compare the safety and efficiency of square and brace sutures.
authors: Department of Obstetrics and Gynecology, Centre Hospitalier Régional d'Orléans, Orléans, France. alouini.s@orange.fr
authors: Souhail
authors: S
authors: Alouini
authors: Sekou
authors: S
authors: Coly
authors: Pascal
authors: P
authors: Mégier
authors: Bruno
authors: B
authors: Lemaire
authors: Louis
authors: L
authors: Mesnard
authors: Alain
authors: A
authors: Desroches
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D006473:Postpartum Hemorrhage / Q000601:surgery*; D012189:Retrospective Studies; D013536:Suture Techniques; D055815:Young Adult