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Hum. Reprod. Advance Access originally published online on November 17, 2007
Human Reproduction 2008 23(1):74-79; doi:10.1093/humrep/dem364
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© The Author 2007. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Uterine compression U-sutures in primary postpartum hemorrhage after Cesarean section: fertility preservation with a simple and effective technique

A. Hackethal1,*, D. Brueggmann1, F. Oehmke1, H.-R. Tinneberg1, M.T. Zygmunt2 and K. Muenstedt1

1 Department of Obstetrics and Gynecology, Justus-Liebig-University of Giessen, Klinikstrasse 32, 35385 Giessen, Germany 2 Department of Obstetrics and Gynecology, Ernst-Moritz-Arndt-University of Greifswald, Wollweberstraße 1,17475 Greifswald, Germany

3 Correspondence address. Tel: +49-641-9945200; Fax: +49-641-9945139; E-mail: andreas.hackethal{at}gyn.med.uni-giessen.de

BACKGROUND: Transmural uterine compression suturing methods are a fertility-preserving alternative in patients with atonic primary postpartum hemorrhage (PPPH), which does not respond to manual compression or drugs. This study evaluated the effectiveness of a modified U-suturing technique in effecting uterine compression in patients with PPPH after Cesarean section.

METHODS: U-suture uterine compression was introduced at our hospital at the beginning of 2005. The medical records of patients with PPPH after Cesarean section who had undergone this treatment, and results of a follow-up and questionnaire were evaluated and our experience with this method was reviewed.

RESULTS: Between January 2005 and September 2007, seven patients underwent uterine compression with U-sutures after PPPH. In all cases, treatment was successful, the hemorrhage was controlled and the uterus preserved. Normal menstruation patterns returned in the five patients who returned the questionnaire and no surgery related morbidities were noted at the follow-up examinations of six patients. The technique was simple to perform in an emergency situation.

CONCLUSIONS: Uterine compression with U-sutures is a highly effective and straightforward emergency procedure which conserves the uterus in these patients.

Key words: atonic bleeding/postpartum hemorrhage/fertility preservation/U-sutures/uterine compression

Submitted on July 30, 2007; resubmitted on October 10, 2007; accepted on October 18, 2007.


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