INTRODUCTION
Postpartum haemorrhage(PPH) is the leading cause of maternal mortality
worldwide1 with about 35% of all maternal deaths
globally attributed to it2 and the adverse effects
more severe in the developing countries3. An African
woman’s lifetime risk of dying from pregnancy-related causes is about
100 times higher than that of a woman in a developed
country3. Every year, about 14 million women around
the world suffer from postpartum haemorrhage4 with
uterine atony being the leading cause of postpartum haemorrhage whatever
the mode of delivery. Its severe forms are often unexpected and may
occur in the absence of recognized risk factor5.
Postpartum heaemorrhage occurs in 4-6% of deliveries6and it is severe in 1 to 2 percent of life births7.
There are many management modalities for postpartum haemorrhage ranging
from the conservative use of drugs like oxytocin, misoprostol etc to
prevent it to more conservative uterine sparing surgeries and finally
hysterectomy as the final treatment8,9. Uterine
compression sutures have been shown to be effective in the management of
postpartum haemorrhage10,11 with reported success
rates ranging from 76% to 100% with an added advantage of preservation
of the uterus12,13. This makes them proven as
essential treatment options for postpartum haemorrhage.
Apart from the B- Lynch sutures first reported in
199717, various methods of uterine compression sutures
have been proposed and have yielded good outcomes with success rates of
76-100%12. In August 2020, the Esike’s technique of
uterine compression method was published as a new, safe, simple and
effective treatment for massive life-threatening postpartum
haemorrhage5. Its use preserves the uterus and the
success rate is 89 percent15.
Despite the impressive effectiveness and safety of uterine compression
suture methods, concern has been raised in some quarters concerning its
safety and preservation of fertility. A few studies have reported that
use of uterine compression sutures can lead to changes in fertility that
might have effect on subsequent pregnancies16-18. This
has made it imperative for any pregnancy outcome from such methods
especially new ones like the Esike’s technique to be reported to the
scientific community since subsequent pregnancies in women desiring more
pregnancies is about the surest way of confirming, not just the safety
and effectiveness of such methods, but also the usefulness of the
preservation of the uterus that is amongst many other advantages that
are inherent in the uterine compression methods of combating postpartum
haemorrhage. We report a successful pregnancy outcome in a multipara
with one previous caesarean section then who had placenta praevia type 4
and subsequently delivered by repeat caesarean section in her last
pregnancy on 14 June 2017 and subsequently had life-threatening PPH that
was controlled with the Esike’s technique with preservation of her
uterus. She conceived and successfully delivered a life 3.7kg male baby
with good outcome at term.