Complications of uterine compression sutures used for the surgical management of postpartum haemorrhage (PPH)

In the modern practice of caesarean delivery, if the uterus was found to be not contracting after the routine of drugs, which make uterus contract, one of the surgical interventions used is a uterine compression suture to make the uterus artificially contract.

Even though there are no large published data, but, there are several small observational studies and case reports of complications suffered by the patients who underwent conservative surgical uterine compression suture technique to control on-going postpartum haemorrhage.

Short term consequences which are usually noted within the first few days to weeks are,
Haematometra/pyometra – collection of blood or pus which is entrapped between the compression sutures in the uterine cavity. Here blood acts as a culture media for the bacteria to thrive and can cause severe infection and sepsis. Usually such patients experience ongoing abdominal pain and spiking temperature and offensive lochia or vaginal discharge

Partial or total uterine wall necrosis – Such patients initially recover well from surgery, but, after few days start feeling unwell, experience non specific lower abdominal pain and feel feverish and occasionally pass sloughed out tissues from the vagina (necrosed uterine tissues)

Long term consequences – which can take few weeks to few months

Persistent vaginal discharge – this could be secondary to apposed uterine walls and entrapment of small amount of fluid above the brace suture line in the uterine cavity

Asherman’s syndrome/uterine synechiae or intrauterine adhesions – the quoted risk is between 1 in 4 to 1 in 5.

Few authors recommend routine surveillance of all patients who underwent uterine compression suture by the way of specialized ultrasound scanning to assess the integrity of myometrium or by the way of MRI. MRI scan can show uterine wall defects, which are usually in the mid anterior or posterior uterine walls.
Hysteroscopy may be required to diagnose and treat the above-mentioned problems.

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