doiSerbia

Uterine compression suture technique in the management of severe postpartum haemorrhage as an alternative to hysterectomy

Stanojević Dušan (Ginekološko-akušerska klinika 'Narodni front', Beograd)
Stanojević Marija (Ginekološko-akušerska klinika 'Narodni front', Beograd)
Zamurović Milena (Ginekološko-akušerska klinika 'Narodni front', Beograd)
Ćirović Anka (Ginekološko-akušerska klinika 'Narodni front', Beograd)
Hajrić Amira (Ginekološko-akušerska klinika 'Narodni front', Beograd)
Rakić Snežana (Ginekološko-akušerska klinika 'Narodni front', Beograd)
Srbinović Pavle (Ginekološko-akušerska klinika 'Narodni front', Beograd)

Introduction. One of the most dramatic conditions in obstetrics is definitely bleeding from the uterus which fails to compress. This condition is known as postpartum atony. When such a condition is diagnosed, the obstetrician has a choice of several conservative methods to stimulate the uterus to contract and several surgical methods to stop the bleeding. The most extreme measure used to save the patient's life and stop the bleeding is hysterectomy. This surgery is characterized by high morbidity, primarily by the loss of woman's fertility. In order to avoid hysterectomy, several authors have introduced the compressive uterine suture technique into gynaecological practice. Objective. The aim of the paper is to demonstrate the technique of applying compressive uterine suture after delivery to stop excessive bleeding, and to present results obtained by this technique. Methods. The paper explains the technique of applying compressive suture to the atonic uterus in cases when all other procedures to stop excessive bleeding after delivery fail. Since uterine atony is the main reason for excessive and uncontrollable bleeding after childbirth, the need to perform such surgery is rather common. Authors demonstrate the technique of applying four compressive sutures which prevent uterus dilation and thus stop the bleeding. Results. Compressive suture technique was used by the authors eight times, seven of which during caesarean section and one after spontaneous delivery. All patients had normal postpartum period and normal involution of the uterus. Conclusion. Although this surgery requires a skilful and experienced obstetrician, the authors find it rather easy to perform and it is suggested to be applied in all cases of uterine atony when excessive bleeding cannot be stopped by other any other method except hysterectomy. This surgical procedure saves the uterus and facilitates quick and easy patient's recovery.

Keywords: uterine atony, compressive suture, postpartum hysterectomy