Letter to the Editor
Uterine isthmus vertical compression suture for controlling uterine corpus bleeding: A possible mechanism of decreasing uterine blood flow
2016 年 4 巻 1 号 p. 45
詳細
2016 年 4 巻 1 号 p. 45
Dear Editor,
We read with interest in the literature entitled “Vertical compression sutures for control of postpartum hemorrhage from a placenta previa in cesarean section —To evaluate the usefulness of this technique”. by Tanaka et al.1) This vertical compression sutures originally reported by Makino et al.2) As the authors described in the literature, double vertical compression sutures contained two different sutures. Uterine isthmus compression sutures were performed for controlling uterine bleeding from lower segment, and modified B-Lynch sutures for controlling uterine corpus bleeding due to uterine atony. Since the paper published, we had been using uterine isthmus vertical compression sutures for placenta previa, however, there was no chance to use modified B-Lynch sutures because several other methods, for example uterotonic agents or uterine balloon tamponade, were substantially effective to seize the uterine corpus bleeding. In addition, empirically we had speculated that uterine isthmus compression sutures decrease uterine corpus bleeding as well. In this letter, we described a case of uterine atony successfully preserved uterus with uterine isthmus vertical compression sutures.
The case was a primipara aged 28 years who had caesarean section due to dystocia of labor after premature rupture of membrane. After the baby was born, uterus started to atony and continuous bleeding from uterine corpus was found even with the usage of intravenous administrations of oxytocine, methyl elgometrine and prostaglandin F2α. Firstly, uterine fundus balloon tamponade with metreurynter was attempted to stop bleeding, however, it end up with no effect. Thus, the uterine isthmus compression sutures were performed, and hemostasis were accomplished. Total volume of blood loss during the surgery was 1,756 g, which was mostly bled before the compression sutures. Metreurynter were deflated and removed a day after the surgery without bleeding. She was able to discharge from the hospital 6 days after the surgery, which was same length of hospital stay for normal caesarean section in the facility.
With the case, we speculated a possible mechanism of hemostasis as we described as follow. Uterine isthmus vertical compression sutures could possibly decrease uterine corpus blood flow with ligating anastomosis of arcuate or/and radial arteries between ascending and descending uterine arteries. Proper reduction of uterine blood flow leads to hemostasis, however, when the effect is excessively given, it may lead to the uterine necrosis as previously reported.3,4) Although this is just a case and further reports are needed to prove this speculation, we assume that the uterine isthmus vertical compression sutures have a potential to stop bleeding from the uterine corpus.
