Waiting 2 to 6 hours after delivery before using uterine compression sutures increases the odds of a hysterectomy by 4 times,
according to the results of a prospective population-based study of 1.2 million women. The authors of the study used the UK
Obstetric Surveillance System to identify all women in the United Kingdom delivering between September 2007 and March 2009
who were treated with uterine compression sutures.
Overall, 211 women were treated with sutures to control postpartum hemorrhage for an estimated usage rate of 18 cases per
100,000 women.
The failure rate leading to hysterectomy was 25% (95% Confidence Interval [CI], 19%–31%). B-Lynch sutures, modified B-Lynch
sutures, and other suture techniques all performed equally; rates of hysterectomy did not differ significantly according to
the method of suture used.
Women aged 35 years and older had a 33% risk compared with a 20% risk for women younger than 35 years. Multiparity was associated
with a 33% risk compared with 14% for nulliparous women. Those either unemployed or with blue-collar jobs had a rate of 28%
compared with 17% for those with white-collar jobs. Vaginal delivery was associated with more than twice the risk as cesarean
delivery (47% vs 22%, respectively), and a delay of 2 to 6 hours in applying uterine compression sutures was associated with
a 42% likelihood of hysterectomy, while a delay of less than 1 hour was associated with a 16% risk. The authors advised carefully evaluating blood loss postpartum to promptly recognize any signs of hemorrhage.
Kayem G, Kurinczuk JJ, Alfirevic Z, Spark P, Brocklehurst P, Knight M; UK Obstetric Surveillance System (UKOSS). Uterine compression
sutures for the management of severe postpartum hemorrhage. Obstet Gynecol. 2011;117(1):14–20.
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