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. 2021 May;47(5):1735-1742.
doi: 10.1111/jog.14695. Epub 2021 Feb 15.

Circular suture of the uterine serosa and myometrium layer around placental attachment site for refractory postpartum hemorrhage

Xueqin Shi  1 , Han Wu  2 , Changyue Liu  3 , Xiaoyan Zhu  1
Affiliations

Circular suture of the uterine serosa and myometrium layer around placental attachment site for refractory postpartum hemorrhage

Xueqin Shi et al. J Obstet Gynaecol Res. 2021 May.

Abstract

Objective: The aim of the study was to analyze the clinical outcomes of circular suture at placental attachment site for refractory postpartum hemorrhage (PPH), which could block blood supply of the serosa and myometrium layer.

Methods: Eighty cases of refractory PPH were enrolled and retrospective analyzed in this study for further analysis from a consecutive single center database between 2010 and 2018. After undergoing circular suture of the uterine serosa and myometrium layer around placental attachment site, surgical and perioperative outcomes were recorded and analyzed.

Results: Among all the patients enrolled, 28 cases (35.0%) of refractory PPH were mainly caused by uterine inertia, 36 cases (45.0%) caused by ectopic placenta, and 2 cases (2.5%) caused by coagulation disorders. After circular suture of the uterine serosa and myometrium layer at placental attachment site, all the uterine active bleeding was controlled below 40 ml without recurrence. The perioperative results were similar between the vaginal and cesarean sections groups.

Conclusions: Circular suture of the uterine serosa and myometrium at the placental attachment site could control refractory PPH with few postoperative complications. Circular suture around placenta site could be applied in time to protect the endometrium even in primary hospital.

Keywords: circular suture; placental attachment site; refractory postpartum hemorrhage; retrospective study; surgical treatment.

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