Is early intervention using Mansoura-VV uterine compression sutures an effective procedure in the management of primary atonic postpartum hemorrhage? : a prospective study

Abd Elaziz A El Refaeey, Hosam Abdelfattah, Alaa Mosbah, Anas M Gamal, Emad Fayla, Waleed Refaie, Abdelhady Zaied, Rafik I Barakat, Amal K Seleem, Mohammed Maher, Abd Elaziz A El Refaeey, Hosam Abdelfattah, Alaa Mosbah, Anas M Gamal, Emad Fayla, Waleed Refaie, Abdelhady Zaied, Rafik I Barakat, Amal K Seleem, Mohammed Maher

Abstract

Background: Postpartum hemorrhage is the leading cause of maternal death, uterine atony accounts for 75-90% of primary postpartum hemorrhage. The efficacy of the Uterine compression suture in the treatment of atonic postpartum hemorrhage is time-tested and can be said to be almost established.The aim of this study was to assess the role of the Mansoura-VV uterine compression suture as an early intervention in the management of primary atonic postpartum hemorrhage.

Methods: This prospective observational study included 108 women with primary atonic PPH over a period of 44 months. Uterine atony was diagnosed when the uterus was soft and failed to respond to ordinary ecbolics. Early intervention by Mansoura-VV uterine compression sutures was carried out within 15 min of the second dose of ecobolics and before progressing to any further surgical procedure.

Results: Following the Mansoura-VV uterine compression sutures, uterine bleeding was controlled in all except one patient (107/108 cases; 99.07%) who required additional bilateral uterine vessels ligation. Another case (0.93%) was subjected to re-laparotomy due to intraperitoneal hemorrhage. Packed RBC transfusion was needed in 10 cases (9.25%). Admission to ICU was needed in 9 cases (8.33%) because of associated medical conditions. One week following the procedure, 1 case (0.93%) was diagnosed with haematometra.

Conclusion: Early intervention in cases of primary atonic PPH using the Mansoura-VV uterine compression sutures is an easy, rapid and effective method in controlling PPH in low resource settings.

Trial registration: The study was registered at clinicaltrial.gov , Identifiers: NCT03117647 "retrospectively registererd" registered at April 7, 2017.

Keywords: Atonic postpartum hemorrhage; Uterine compression sutures.

Figures

Fig. 1
Fig. 1
Schematic representation of the Mansoura-VV compression sutures: A100 cm catgut no 2 was thrown to form 2 equal parts (each 50 cm) on a blunt straightened semicircular 70-mm needle. The needle transfixes the right uterine wall from anterior to posterior, about 2 cm below the hysterotomy incision (a, b). After transfixation, the cat gut was divided into 2 longitudinal medial (M) and lateral (L) threads (c). The free (aL and pL) ends of the lateral threads tied above the fundus about 3 cm from the right cornual border forming the lateral limb of the V suture (d). 5-The free ends of the medial threads (aM and pM) were tied above the fundus 2–3 cm medial to the lateral limb completing the V suture (e). Using a similar technique, another V suture was laid on the left side, and then the VV suture is complete (f)

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