Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Unit, Istanbul Kanuni Sultan Suleyman Health Training and Research Medical Center, Hamidiye School of Medicine, University of Health Sciences, Istanbul, Turkey.
Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Unit, Basaksehir City Hospital, Hamidiye School of Medicine, University of Health Sciences, Istanbul, Turkey.
Eur J Obstet Gynecol Reprod Biol. 2021 May;260:208-211. doi: 10.1016/j.ejogrb.2021.03.038. Epub 2021 Apr 2.
Postpartum hemorrhage is a leading cause of maternal morbidity and mortality worldwide. Uterine atony is the most common cause of bleeding accounting for ∼80 % of cases of postpartum hemorrhage. To reduce maternal morbidity and mortality due to bleeding caused by uterine atony even under limited resources, a simple and effective procedure that can be easily applied by all obstetricians and junior physicians is required. The aim of this study was to evaluate the efficacy of novel three vertical compression sutures for severe postpartum hemorrhage.
Two vertical sutures are transfixed, one on each side of the lower uterine segment, from anterior to posterior over the bladder reflection avoiding the endometrial cavity, and tied over the fundus. The lateral sutures should be placed approximately 2 cm from the lateral edge of the lower uterus and approximately 4 cm from the cornual border, because the uterus widens upward from below. The third vertical suture is placed in the midline at the same level as the two vertical sutures, passing the endometrial cavity from anterior to posterior, and is tied in the middle of the fundus, where the three sutures are positioned side-by-side.
We report 25 cases of postpartum hemorrhage secondary to life-threatening severe uterine atony treated with this novel approach of using three vertical compression sutures. Success was achieved in 24/25 (96 %) of cases treated with three vertical sutures, without requiring hysterectomy except one.
To reduce maternal morbidity and mortality, three vertical compression sutures as a novel technique, can be attempted before applying other more complex interventions. It does not require any extra skill or training, and is an ideal option as its simplicity allows it to be performed by all obstetricians, including junior obstetric staff.
产后出血是全球孕产妇发病率和死亡率的主要原因。宫缩乏力是出血的最常见原因，占产后出血病例的 80%左右。为了降低因宫缩乏力导致的出血引起的孕产妇发病率和死亡率，即使在资源有限的情况下，也需要一种简单有效的程序，所有产科医生和初级医生都可以轻松应用。本研究旨在评估新型三垂直压迫缝合术治疗严重产后出血的疗效。
在膀胱反射上方从前到后穿过下段子宫的两侧各穿过两垂直缝线，避开子宫内膜腔，并在子宫底打结。侧缝线应距子宫下段的外侧边缘约 2 厘米，距角状边缘约 4 厘米，因为子宫从下向上变宽。第三根垂直缝线在与两根垂直缝线相同的水平线上置于中线，从前到后穿过子宫内膜腔，并在子宫底的中间打结，三根缝线并排定位。
我们报告了 25 例因危及生命的严重宫缩乏力引起的产后出血病例，采用这种新型三垂直压迫缝合术治疗。24/25（96%）例采用三垂直缝合成功，除 1 例外均无需子宫切除术。
为了降低孕产妇发病率和死亡率，三垂直压迫缝合术作为一种新的技术，可以在应用其他更复杂的干预措施之前尝试。它不需要任何额外的技能或培训，是一种理想的选择，因为其简单性允许所有产科医生，包括初级产科医生都可以进行操作。
