Delaying postpartum compression sutures raises hysterectomy risk

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.

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.