Department of Obstetrics, Gynecology and Reproductive Medicine, CHULN - Santa Maria Hospital, Lisbon, Portugal.
Department of Obstetrics, Gynecology and Reproductive Medicine, CHULN - Santa Maria Hospital, Lisbon, Portugal.
Eur J Obstet Gynecol Reprod Biol. 2022 Oct;277:27-31. doi: 10.1016/j.ejogrb.2022.08.008. Epub 2022 Aug 12.
Postpartum hemorrhage (PPH) is mostly caused by uterine atony and is the leading cause of maternal death. Hysterectomy may be necessary in severe cases, but uterine compressive sutures are an uterine-sparing alternative. In 2005, Alcides Pereira proposed a technique with serial superficial stiches around the uterus. To date, there were no further reports on its clinical use.
To evaluate a tertiary center's experience with Alcides-Pereira's compressive uterine sutures for severe PPH due to uterine atony, reviewing its efficacy, morbidity, and impact on reproductive outcomes.
An 11-year retrospective cohort study of Alcides-Pereira's sutures for PPH at a single tertiary hospital. Demographic and obstetric data were collected. Details of subsequent pregnancies and fertility plans were collected through a telephonic interview. Comparison between women in which the sutures were effective and ineffective to prevent hysterectomy was made.
Alcides-Pereira's sutures were applied in 23 patients with PPH due to uterine atony. The technique was successful in controlling the hemorrhage and avoiding hysterectomy in 20 patients (87%). When successful, the sutures avoided the need for any blood therapy in 55% (RR 0.45, 95% CI 0.28-0.73) of patients, intensive care unit admission in 80% (RR 0.2, 95% CI 0.08-0.48) and significantly shortened the length of hospital stay. All patients with preserved uterus resumed their usual menstrual pattern. One had a subsequent term vaginal delivery; one had three first trimester miscarriages. All other patients did not try to conceive.
Alcides-Pereira's sutures are a feasible, uterine-sparing technique, providing an effective and safe option for PPH.
产后出血（PPH）主要由子宫收缩乏力引起，是产妇死亡的主要原因。在严重的情况下可能需要进行子宫切除术，但子宫压迫缝合术是一种保留子宫的替代方法。2005 年，Alcides Pereira 提出了一种环绕子宫的连续浅层缝合技术。迄今为止，尚无关于其临床应用的进一步报道。
评估一家三级中心使用 Alcides-Pereira 子宫压迫缝合术治疗因子宫收缩乏力导致的严重产后出血的经验，评估其疗效、发病率以及对生殖结局的影响。
这是一项在一家三级医院进行的回顾性队列研究，对 Alcides-Pereira 缝线治疗产后出血的病例进行了 11 年的回顾性研究。收集了人口统计学和产科数据。通过电话访谈收集了后续妊娠和生育计划的详细信息。比较了缝线有效和无效以预防子宫切除的两组患者的结果。
23 例因子宫收缩乏力导致产后出血的患者使用了 Alcides-Pereira 缝线。该技术在 20 例患者（87%）中成功控制了出血并避免了子宫切除。当缝线成功时，它避免了 55%（RR 0.45，95%CI 0.28-0.73）的患者需要任何血液治疗，80%（RR 0.2，95%CI 0.08-0.48）的患者需要入住重症监护病房，并显著缩短了住院时间。所有保留子宫的患者恢复了正常的月经模式。其中 1 例足月阴道分娩，1 例发生 3 次早期流产。其余所有患者均未尝试怀孕。
Alcides-Pereira 缝线是一种可行的、保留子宫的技术，为产后出血提供了一种有效且安全的选择。
