Department of Obstetrics and Gynecology, Centre Hospitalier Régional d'Orléans, Orléans, France.
Am J Obstet Gynecol. 2011 Oct;205(4):335.e1-6. doi: 10.1016/j.ajog.2011.05.006. Epub 2011 May 10.
The purpose of this study was to evaluate the efficiency and morbidity of multiple square sutures in severe postpartum hemorrhage.
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.
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.
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.
本研究旨在评估多点式方块缝合术治疗严重产后出血的效率和发病率。
回顾性研究纳入了在一家三级妇产中心的 26605 例分娩中，30 例因严重产后出血而进行的多点式方块缝合术。主要观察指标为止血能力和 3 个月时宫腔镜评估子宫腔情况。
30 例中的 28 例（93%）通过多点式方块缝合术成功止血。20 例妇女在进行多点式方块缝合术后接受了宫腔镜检查。8 例妇女（40%）无宫腔粘连，9 例妇女（45%）宫腔粘连薄且局限，可通过宫腔镜尖端轻松切除；2 例妇女有中度宫腔粘连，需要切除。1 例患者发生子宫内膜炎后出现严重宫腔粘连。
多点式方块缝合术在控制严重产后出血和保留子宫方面是有效且安全的，大多数情况下可以保留子宫。尽管一些患者存在中度或重度粘连，但宫腔镜检查最常见的发现是子宫腔正常或轻度粘连，易于切除。前瞻性研究可能有助于比较方块缝合术和支撑缝合术的安全性和效率。
