Discussion: -
In obstetrics practice in cases with atonic PPH when the medical
measures fail, the different methods have been devised by different
surgeons to stop bleeding.
A study conducted by J. Seror et al. in 2005 (2) found balloon
tamponade to be associated with risk of infection and resumption of
bleeding after taking it out, in 17.06% cases in a large series. The
patients in whom bleeding restarted were shifted for uterine artery
embolization.
Different compression sutures have been devised to oppose the walls of
the uterine cavity and also to reduce blood supply to the uterus at the
same time, to achieve haemostasis at placental site (3) .
Compression sutures practiced are:
- B Lynch Compression Suture (1)
- Hayman’s Sutures (4)
- CHO’s Square Sutures (5)
- Mansoura VV sutures (6)
These compression sutures required a skilled obstetrician for the
technique as optimum degree of tension to achieve compression of the
large bulk of tissue is required while tying the knot without getting
cut through.
Saad Benkirane, at all 2017 (7) has reported
uterine necrosis following combination of uterine compression sutures
with vascular ligation done during postpartum haemorrhage. The other
reported complications are pyometra erosion of strap through the uterine
wall, uterine ischaemia and synechie. The frequency of complications
still remain unclear.
To overcome the aforesaid complications, removable uterine compression
sutures were devised by Zhang ZW 2015(8) , but they found the
method of suture removal to be cumbersome.
The present study includes a limited number of cases but we hope if this
method is practiced at a larger level where ever required in future it
will be a step overcoming many problems in the management of PPH.