Risk of synechiae following uterine compression sutures in the management of major postpartum haemorrhage

Abstract

Objective: To determine with hysteroscopy or hysterosalpingogram the risk of uterine synechiae following uterine compression sutures for major postpartum haemorrhage (PPH) caused by uterine atony.

Design: A retrospective observational study.

Setting: Department of Obstetrics and Gynaecology, Beaujon Hospital, Clichy, France.

Population: One hundred and ninety-seven women with PPH between 2007 and 2010. One hundred and thirteen women (57.4%) were transferred as an emergency to our institution from other centres.

Methods: Of the 197 women, 94 with PPH had uterine arterial embolisation and 33 with major PPH were managed with surgical uterine compression sutures (Hackethal technique). The women were invited to undergo a control hysteroscopy or hysterosalpingogram, after postpartum consultation, to assess the uterine cavity.

Main outcome measure: The prevalence of subsequent uterine synechiae.

Results: Uterine compression sutures succeeded in controlling PPH in 26 of 33 women (78.8%). Seven needed a hysterectomy. Among women with a preserved uterus, 15 underwent an exploration of the uterine cavity, including hysteroscopy (12) or hysterosalpingogram (8). Four women (26.7%) developed uterine synechiae and one had a subsequent pregnancy 18 months after uterine compression sutures. The median time between delivery and hysteroscopy or hysterosalpingogram was 9.3 months (2.4-34.8 months).

Conclusions: This study suggests a significant risk of uterine synechiae after placement of compression sutures for PPH that transverse the uterine cavity. Postoperative uterine synechiae might be underestimated, and their prevalence and clinical significance should be assessed in long-term follow-up studies.