Postpartum hemorrhage (PPH) remains a major cause of maternal morbidity, and causes an estimated 125,000 deaths worldwide each year. The use of surgical compression sutures has gained interest as a means of avoiding hysterectomy when uterotonic drugs fail to control massive bleeding. The goal is to compress the uterine vascular sinus without occluding the uterine arteries or uterine cavity. The B-Lynch suture has been most widely used but, in 2002, Hayman et al. proposed a simpler approach that is more easily and more rapidly applied. In addition, it precludes the need to do a lower-segment hysterotomy when PPH follows vaginal delivery. There is, however, concern about occlusion of the uterine cavity and blood entrapment because the uterus is transfixed from front to back when placing the suture.
The investigators evaluated the Hayman technique in 11 consecutive women with PPH exceeding 2000 ml in whom pharmacological measures had not controlled bleeding and who were becoming hemodynamically unstable. In all patients but one, 91% of those operated on, the uterus was effectively compressed and hemostasis established, and no further intervention was required. One patient with unsuspected placenta accreta ultimately required hysterectomy because of intractable bleeding and hemodynamic instability. Two patients developed disseminated intravascular coagulation intraoperatively, but the postoperative course was uncomplicated in all instances. During a median follow-up of 11 months, one woman conceived 10 months after the procedure and, when last seen at 15 weeks’ gestation, was doing well. There was no delay in the return of normal menses after breast-feeding ceased.
The Hayman compression suture technique appears to be an effective and safe conservative approach to the surgical management of major PPH.
Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy; and Department of Obstetrics and Gynecology, University of Berne, Berne, Switzerland
BJOG Int J Obset Gynaecol 2007;114:362–365