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.
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Source: PubMed