Hani Akoury1, Christopher Sherman. 1. Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Division, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Abstract
BACKGROUND: Postpartum hemorrhage (PPH) is a significant factor in maternal morbidity and mortality. Successful techniques using compression sutures to control PPH have been described, in some cases using a combination of techniques. We describe a case in which compression sutures to control PPH were complicated by subsequent myometrial necrosis. CASE: A healthy 32-year-old woman, gravida 3, para 0, underwent Caesarean section at 41 weeks' gestation after failure to progress in labour. One B-Lynch plus two Cho sutures were used to control postpartum hemorrhage. During a subsequent pregnancy, a large triangular myometrial defect was identified in the mid-anterior uterine wall and two smaller defects in the posterior wall. CONCLUSION: Patients should be informed about the possible complications of the use of compression sutures and the need to undergo postoperative follow-up to confirm uterine wall integrity. We propose the establishment of a national registry of women who undergo placement of compression sutures, in order to document the efficacy and the long-term and short-term complications of this procedure.
BACKGROUND: Postpartum hemorrhage (PPH) is a significant factor in maternal morbidity and mortality. Successful techniques using compression sutures to control PPH have been described, in some cases using a combination of techniques. We describe a case in which compression sutures to control PPH were complicated by subsequent myometrial necrosis. CASE: A healthy 32-year-old woman, gravida 3, para 0, underwent Caesarean section at 41 weeks' gestation after failure to progress in labour. One B-Lynch plus two Cho sutures were used to control postpartum hemorrhage. During a subsequent pregnancy, a large triangular myometrial defect was identified in the mid-anterior uterine wall and two smaller defects in the posterior wall. CONCLUSION:Patients should be informed about the possible complications of the use of compression sutures and the need to undergo postoperative follow-up to confirm uterine wall integrity. We propose the establishment of a national registry of women who undergo placement of compression sutures, in order to document the efficacy and the long-term and short-term complications of this procedure.