Uterine compression sutures for the management of severe postpartum hemorrhage.
Kayem G., Kurinczuk JJ., Alfirevic Z., Spark P., Brocklehurst P., Knight M., U.K. Obstetric Surveillance System (UKOSS) None.
OBJECTIVE: To assess maternal outcomes after uterine compression suture use and to characterize the risk factors for failure, defined as cases that proceeded to hysterectomy. METHODS: A prospective population-based study of 1.2 million women delivering was conducted using the U.K. Obstetric Surveillance System to identify all women in the United Kingdom delivering between September 2007 and March 2009 and treated with uterine compression sutures. RESULTS: Two hundred eleven women were treated with a uterine compression suture to control postpartum hemorrhage. The overall rate of failure, leading to hysterectomy, was 25% (95% confidence interval, 19–31%); there were no significant differences in failure rates among B-Lynch sutures, modified B-Lynch sutures, and other suture techniques. Women were more likely to have a hysterectomy if they were aged 35 years or older (33% compared with 20% aged younger than 35 years), multiparous (33% compared with 14% in nulliparous), in unemployed and routine or manual occupational groups (28% compared with 17% in managerial or professional groups), had a vaginal delivery (47% compared with 22% in the cesarean delivery group), or a delay of between 2 and 6 hours from delivery to uterine suture compression (42% compared with 16% with delay less than 1 hour). CONCLUSION: A prolonged delay of 2–6 hours between delivery and uterine compression suture was independently associated with a fourfold increase in the odds of hysterectomy. These data emphasize the need for a careful evaluation of blood loss after delivery to avoid any prolonged delay in recognition of hemorrhage. LEVEL OF EVIDENCE: III