Uterine folding hemostasis: a simpler and safer technique for controlling atonic postpartum hemorrhage

Objective To observe the efficacy and safety of a uterine folding hemostatic technique in controlling atonic postpartum hemorrhage (PPH) during cesarean delivery. Methods Thirty-nine women with severe postpartum bleeding from uterine inertia, which did not react to conventional initial management pr...

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Bibliographic Details
Published in:Archives of gynecology and obstetrics 2016-10, Vol.294 (4), p.689-695
Main Authors: Li, Guang-Tai, Li, Guang-Rui, Xu, Hong-Mei, Wu, Bao-Ping, Wang, Xiao-Nian
Format: Article
Language:English
Subjects:
Adult
Cesarean Section - adverse effects
Embolization, Therapeutic - methods
Endocrinology
Female
Gynecology
Hemostasis
Hemostasis, Surgical - methods
Human Genetics
Humans
Hysterectomy
Maternal-Fetal Medicine
Medicine
Medicine & Public Health
Obstetrics/Perinatology/Midwifery
Postpartum Hemorrhage - etiology
Postpartum Hemorrhage - surgery
Pregnancy
Suture Techniques - adverse effects
Sutures
Uterine Inertia - surgery
Uterus - surgery
Young Adult
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Summary:Objective To observe the efficacy and safety of a uterine folding hemostatic technique in controlling atonic postpartum hemorrhage (PPH) during cesarean delivery. Methods Thirty-nine women with severe postpartum bleeding from uterine inertia, which did not react to conventional initial management protocols, underwent a uterine folding hemostasis. The procedure was to fold the uterine fundus onto the anterior wall of the corpus uterus using an absorbable suture that thread tautly through the inner myometrial layer of the uterus 1–3 cm below the fundus (not entered into uterine cavity) and 1–2 cm above and below the CS incision (entered into uterine cavity 2–4 cm medal to bilateral border of the uterus). Results The technique was sufficient to stanch bleeding immediately in 32 patients (82.1 %). Seven women underwent hypogastric arteries ligation (1 case) or uterine arterial embolization (6 cases) because of continuous bleeding after the procedure. There were no morbidities or abnormalities of the uterus in these 32 patients. Eight women had pregnancies after this hemostasis and the others lacked the desire for future pregnancy. Conclusion Uterine folding hemostasis is a simple, safe and effective technique to control the atonic PPH.
ISSN:0932-0067
1432-0711
DOI:10.1007/s00404-016-4009-x