What is the role of transmural uterine compression sutures in the treatment of postpartum hemorrhage (PPH)?

Updated: Jun 27, 2018
  • Author: John R Smith, MD, FACOG, FRCSC; Chief Editor: Ronald M Ramus, MD  more...
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Answer

Recent case series and case reports advocate the use of transmural uterine compression sutures to rapidly control bleeding. The initial reports described the B-Lynch technique, which involves opening the lower segment and passing a suture through the posterior uterine wall and then over the fundus to be tied anteriorly. [72, 73] A similar technique has been described without opening the uterus. A long, straight needle is passed anterior to posterior through the lower uterine segment; the suture is passed over the fundus and then tied anteriorly. [74] Both techniques use bilateral stitches. The most recent variant uses multiple stitches passed transmurally and tied anteriorly at various points over the uterine body. This technique may be focused in the area of the placental bed in cases of abnormal placentation. [75] All of these procedures effectively produce tamponade by compressing together the anterior and posterior walls.

Follow-up reports suggest a normal return to menses and fertility, but the number of cases is small. The techniques have the advantage of being very simple to perform and may be a rapidly effective alternative to hysterectomy. [72]


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