DISCUSSION
Postpartum haemorrhage is the leading cause of maternal mortality
worldwide with uterine atony implicated in about 80 percent of its
causes. Our patient had postpartum haemorrhage which was due to uterine
atony. The compression suture method has been shown to be a safe and
effective uterus-sparing method of treating this scourge of women.
Effectiveness, safety and preservation of the uterus are about the
greatest advantages of this method of treatment of postpartum
haemorrhage especially for women who have not completed their
reproductive carreer and had postpartum haemorrhage as in our patient.
Esike’s technique is a uterine compression method and it was effective
and safe in controlling the life-threatening PPH in Mrs O.I. and it
preserved her uterus. Pregnancy outcome can be taken to be one of the
best confirmations of the safety and fertility preserving function of
this method of combating postpartum haemorrhage. Mrs O.I. was treated
with Esike’s technique, subsequently got pregnant and successfully gave
birth to her baby.
Despite the fact that the observation that many women who have
experienced life-threatening delivery and received uterine compression
suture treatment for their life threatening postpartum haemorrhage may
less frequently wish for future pregnancy14 is
understandable, for those that still desire pregnancy like Mrs O. I,
getting pregnant is important, and indeed key, to their satisfaction,
well being and fulfillment as women. The above-mentioned woman, Mrs O.I
who had her life–threatening postpartum haemorrhage treated by Esike’s
technique got pregnant and had an uneventful antenatal period and a safe
delivery of her baby without complications and with good Apgar score for
her baby. These attest to the safety and good fertility preserving
feature of the Esike’s technique. The fact that the pregnancy preceding
this good pregnancy outcome was further complicated by a previous
caesarean section and placenta praevia type 4 and that the delivery of
the preceding pregnancy was also by caesarean section further buttress
both the effectiveness of the Esike’s technique and its safety.
Other studies have also shown that other uterine compression methods of
controlling postpartum haemorrhage are safe and have fertility sparing
effects. Lui et al in their series of 23 women with uterine compression
suture treatment for postpartum haemorrhage reported 3 women conceiving
and 2 carrying their pregnancies to term successfully and
deliverying16, concluding that uterine compression
suture methods of treating PPH is safe and an effective alternative of
avoiding hysterectomy with preservation of the uterus.
Also Kim et al19 found a subsequent pregnancy rate in
4 out of their 9 patients with uterine compression suture for postpartum
haemorrhage who were followed up ie 44.4%. An et al17in their series recorded 34(81%) of women that desired pregnancy who
got pregnant and delivered at term. This was not statistically different
from those who did not have compression suture treatment and desired
pregnancy, got pregnant and delivered at term.
From the foregoing, Esike’s Technique has further been shown, like other
uterine compression methods, to be effective, safe with not only
preservation of the uterus but also to be fertility preserving. There is
no doubt that definitely more of such pregnancy outcomes are still
needed to further deepen these attributes of the Technique but this one
case points salutarily in this direction.