[Clinical research on bilateral arcuate artery suture hemostasis of corpus uteri for postpartum hemorrhage due to uterine inertia during caesarean section].

OBJECTIVES

To investigate the effect of bilateral arcuate artery suture hemostasis of corpus uteri (haemostasia) for postpartum hemorrhage due to uterine inertia during caesarean section, and to explore the change of blood vessels and blood flow of the uterus after surgery.

METHODS

From May 2009 to Dec. 2011, the 212 patients in No. 202 People's Liberation Army Hospital received bilateral arcuate artery suture hemostasis of corpus uteri for postpartum hemorrhage due to uterine inertia during caesarean section. Among them, 127 patients who failed to respond to conservative management and received haemostasia were defined as the 'haemostasia' group. 23 patients who received the suture after they failed to respond to conservative management and other conventional surgical hemostasis were defined as the 'other + haemostasia' group. 62 patients who received the suture simultaneously with conservative management were defined as the 'drug + haemostasia' group. The suture was done by the following steps: (1) The uterus should be exteriorised, and the fundus of uterus should be towards the head. (2) Transfix the anterior and posterior wall of corpus uteri with big blunt round needle and absorbable suture. The entry point was 2 cm above the uterine incision and 2 cm to lateral border of corpus uteri. The suture spanned the fundus of uterus, and was stretched tightly in front of the fundus, then tied knots were made. Bleeding volume, prompt hemostatic rate, effect rate, total effect rate and operation time were recorded. The resistance index (RI) of uterine artery, systolic/diastolic blood pressure (S/D), the visualization ratio of uterine artery and the mean value of artery diameter were obtained through color Doppler ultrasonography and enhancement CT 6 - 12 months after the surgery.

RESULTS

(1) In the 'drug + haemostasia' group, the bleeding volume was (532 ± 28) ml. The operation time was (34 ± 3) min, and the prompt hemostatic rate was 97%. While the 'haemostasia' group had more bleeding volume, longer operation time and lower prompt hemostatic rate than the 'drug + haemostasia' group, with no statistically significant difference (P > 0.05). In 'other + haemostasia' group, the bleeding volume was (1379 ± 95) ml. The operation time was (79 ± 15) min, and the prompt hemostatic rate was 78%. The differences were significant when compared to the other groups (P < 0.01). There was no statistically significant difference on total effect rate among the three groups (P > 0.05). (2) There was no statistically significant difference on the RI and S/D of bilateral uterine artery among all the groups 6-12 months after the surgery. (3) The visualization ratio of left uterine artery of the 'other + haemostasia' group was lower (87%) than the 'haemostasia' group (97%) and the 'drug + haemostasia' group (95%, P < 0.05). There was no statistically significant difference between the 'haemostasia' group and the 'drug + haemostasia' group on the visualization ratio of bilateral uterine artery and the mean value of bilateral uterine artery diameter (P > 0.05).

CONCLUSIONS

The bilateral arcuate artery suture hemostasis of corpus uteri is a simple, rapid, effective and safe method to control postpartum hemorrhage due to uterine inertia during caesarean section. The ovary and uterine blood flow are not affected after the surgery.