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Cordeiro Féria B, Nazaré P, Figueiredo J, Neves Gomes I, Pereira A. Efficacy, Complications and Effects of Alcides Pereira's Sutures in the Management of Uterine Atony: A Retrospective Study. ACTA MEDICA PORT 2024; 37:518-525. [PMID: 38447018 DOI: 10.20344/amp.20429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 11/08/2023] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Uterine compressive sutures are conservative measures applied in cases of severe postpartum hemorrhage unresponsive to uterotonics. Pereira's suture was introduced in 2005 and consists of two longitudinal and three transverse non-transfixes sutures. Previous studies reported favorable results, highlighting its benefits and value. The aim of this study was to assess the efficacy, complications, and impact on fertility and future pregnancies of Pereira's suture applied in cases of uterine atony and postpartum hemorrhage. METHODS An observational retrospective study was performed by consulting the medical records of women treated with Pereira's compressive sutures in a tertiary center between January 2013 and December 2022. We registered demographic data, pregnancy outcomes, short-term complications, and outcomes of subsequent pregnancies. RESULTS A total of 50 women were treated with Pereira's suture. The overall success rate was 96% and no hysterectomies were performed. Women who had sutures performed during an intra-cesarean section had better outcomes than those who had an after-cesarean section. Complications were reported in 12% (n = 6) of women, with the most frequent being pelvic infection (n = 3) and abdominal pain (n = 3). Regarding fertility, all women desiring a future pregnancy (n = 5) were able to conceive, resulting in three live births. CONCLUSION Pereira's suture is a type of suture that provides numerous advantages and should be considered when first-line medical treatment fails. When applied at an early stage, the sutures may prevent maternal morbidity. The Alcides Pereira's suture is a safe technique and appears to preserve fertility.
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Affiliation(s)
| | - Patrícia Nazaré
- Serviço de Ginecologia e Obstetrícia. Hospital Garcia de Orta. Almada. Portugal
| | - Joana Figueiredo
- Serviço de Ginecologia e Obstetrícia. Hospital Garcia de Orta. Almada. Portugal
| | - Inês Neves Gomes
- Serviço de Ginecologia e Obstetrícia. Hospital Garcia de Orta. Almada. Portugal
| | - Alcides Pereira
- Serviço de Ginecologia e Obstetrícia. Hospital Garcia de Orta. Almada. Portugal
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Harzif AK, Nurbaeti P, Andyra AF, Wiweko B. Challenges and diagnosis in therapy of secondary amenorrhoea in caesarean section patient with postpartum haemorrhage B-lynch sutures: a case report. Ann Med Surg (Lond) 2024; 86:1106-1111. [PMID: 38333262 PMCID: PMC10849346 DOI: 10.1097/ms9.0000000000001603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/29/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction and importance International Federation of Gynecology and Obstetrics (FIGO) and WHO report the incidence of postpartum haemorrhage (PPH) reaches 1-10% and contributes to an increase in postpartum maternal mortality with uterine atony as the most common cause. B-Lynch method is a suturing technique to overcome PPH. Although this method has proven useful as an emergency life-saving measure, the post-procedure complications are still able to occur. Presentation of case The patient was not menstruating for 14 months after giving birth through caesarean section with B-Lynch due to PPH. Before pregnancy, she had regular menstruation cycle and normal menstrual duration. Her general and gynaecological status were normal. Ultrasound showed the impression of uterine hypoplasia and endometrium that were difficult to assess while both ovaries were normal. Diagnostic hysteroscopy showed a severe degree of Asherman's syndrome. The results of FSH, LH and estradiol were normal. Discussion B-lynch suture is performed as a method to stop PPH in uterine atony. Secondary amenorrhoea occurs as a complication of B-lynch. Compression action of B-lynch can cause progressive myometrium necrosis resulting in synechiae and blockade of uterine blood flow. This will interfere with the development of the uterus. Intrauterine adhesions and amenorrhoea with normal levels of FSH, LH, and estradiol support the diagnosis of Asherman's syndrome. Conclusion This case shows that the B-Lynch procedure, which is the worldwide recommended method for treating postpartum haemorrhage due to its high success rate, can cause complications of Asherman's syndrome and cause secondary amenorrhoea.
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Affiliation(s)
- Achmad Kemal Harzif
- Department of Obstetrics and Gynaecology, Faculty of Medicine University of Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Han L, Zhang B, Xu H, Yin H, Pang Y, Zhang X, Zhai Q, Liu X, Wang Y, Zhang C, Xu Y, Liu Y, Chen X. A new step-wise surgical technique of knapsack-like uterine compression sutures for intractable postpartum hemorrhage in cesarean section. BMC Pregnancy Childbirth 2024; 24:9. [PMID: 38166803 PMCID: PMC10759382 DOI: 10.1186/s12884-023-06208-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Intractable postpartum hemorrhage (PPH) during cesarean section has been a significant concern for obstetricians. We aimed to explore the effectiveness and safety of a new type of uterine compression suture, the step-wise surgical technique of knapsack-like sutures for treating intractable PPH caused by uterine atony and placenta factors in cesarean section. METHODS The step-wise surgical technique of knapsack-like sutures was established on the basis of the artful combination of vertical strap-like sutures and an annular suture-ligation technique. This novel surgical technique was applied to 34 patients diagnosed with PPH during cesarean section due to severe uterine atony and placental factors in our department. The hemostatic effects, clinical outcomes and follow-up visit results were all reviewed and analyzed. RESULTS This new uterine compression suture successfully stopped bleeding in 33 patients, and the effective rate was 97.06%. Only 1 patient failed and was changed to use bilateral uterine arterial embolization and internal iliac artery embolization. The follow-up visits indicated that 33 patients restored menstruation except for 1 who was diagnosed with amenorrhea. The gynecological ultrasound tests of all the patients suggested good uterine involutions, and they had no obvious complaints such as hypogastralgia. CONCLUSIONS This step-wise surgical technique of knapsack-like uterine compression sutures can compress the uterus completely. It is a technique that can conserve the uterus and fertility function without special equipment in caesarean section for PPH, with the characteristics of being safe, simple and stable (3 S) with rapid surgery, reliable hemostasis and resident doctor to operation (3R).
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Affiliation(s)
- Lei Han
- Department of Reproductive Medicine, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China.
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, 401120, China.
| | - Baolin Zhang
- Department of Reproductive Medicine, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China
- Department of Obstetrics and Gynecology, Binzhou Central Hospital, Binzhou City, 251700, Shandong Province, P. R. China
| | - Huishu Xu
- Department of Reproductive Medicine, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China
| | - Hongmei Yin
- Department of Reproductive Medicine, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China
- Department of Obstetrics and Gynecology, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China
| | - Yiwei Pang
- Department of Reproductive Medicine, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China
- Department of Obstetrics and Gynecology, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China
| | - Xianghui Zhang
- Department of Reproductive Medicine, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China
- Department of Obstetrics and Gynecology, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China
| | - Qingliang Zhai
- Department of Reproductive Medicine, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China
- Department of Obstetrics and Gynecology, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China
| | - Xiaofeng Liu
- Department of Reproductive Medicine, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China
| | - Yanlin Wang
- Department of Reproductive Medicine, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China
| | - Caiying Zhang
- Department of Postgraduate Student Office, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China
| | - Yingjiang Xu
- Department of Interventional Vascular Surgery, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China
| | - Yanni Liu
- Department of Obstetrics and Gynecology, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China.
| | - Xuemei Chen
- Department of Obstetrics and Gynecology, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China.
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Muacevic A, Adler JR, Prasad MK, Singh AV, Sharma S, Singh B, Singh TH, Kumar P, Singh HV, Singh S. Obstetric and Maternal Outcomes After B-Lynch Compression Sutures: A Meta-Analysis. Cureus 2022; 14:e31306. [PMID: 36514660 PMCID: PMC9734287 DOI: 10.7759/cureus.31306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 11/11/2022] Open
Abstract
This review article aimed to determine the obstetric and maternal outcomes after B-Lynch compression sutures to control atonic postpartum hemorrhage (PPH). This meta-analysis was performed after registering the protocol in the PROSPERO database with the registration number CRD42022355358. Two independent reviewers systematically searched electronic databases and search engines (PubMed, Cochrane Library, and Google Scholar) to retrieve published articles from inception to July 2022. The obstetric and maternal outcomes after the B-Lynch compression suture were computed using the random-effects model in pooled proportion with a 95% confidence interval (CI). Meta-regression analysis and subgroup analysis were performed to explain any source of possible heterogeneity. Quality assessment of the included studies was done using Joanna Briggs Institute (JBI) tools which are critical appraisal tools for systematic reviews and meta-analyses. This meta-analysis included a total of 30 studies involving 1,270 subjects. The pooled proportion of B-Lynch suture alone was 91% (95% CI = 82-97%). The combined proportion of B-Lynch suture plus another compression suture was 1% (95% CI = 0-3%), and the pooled proportion of B-Lynch suture plus vessel ligation was 3% (95% CI = 1-6%). The pooled proportions of PPH controlled and hysterectomies were 94% (95% CI = 91-97%, I2 = 65.3%) and 7% (95% CI = 4-10%, I2 = 72.13%), respectively. Therefore, B-Lynch suture (either alone or in combination with other techniques) is a simple and effective measure to control atonic PPH.
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