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.