Efficacy, Complications and Effects of Alcides Pereira’s Sutures in the Management of Uterine Atony: A Retrospective Study

Authors

  • Beatriz Cordeiro Féria Serviço de Ginecologia e Obstetrícia. Hospital Garcia de Orta. Almada.
  • Patrícia Nazaré Serviço de Ginecologia e Obstetrícia. Hospital Garcia de Orta. Almada.
  • Joana Figueiredo Serviço de Ginecologia e Obstetrícia. Hospital Garcia de Orta. Almada.
  • Inês Neves Gomes Serviço de Ginecologia e Obstetrícia. Hospital Garcia de Orta. Almada.
  • Alcides Pereira Serviço de Ginecologia e Obstetrícia. Hospital Garcia de Orta. Almada.

DOI:

https://doi.org/10.20344/amp.20429

Keywords:

Postpartum Hemorrhage/surgery, Postpartum Period, Suture Techniques, Uterine Inertia

Abstract

Introduction: Uterine compressive sutures are conservative measures applied in cases of severe postpartum hemorrhage unresponsive to uterotonics. Pereira’s suture was introduced in 2005 and consists of two longitudinal and three transverse non-transfixes sutures. Previous studies reported favorable results, highlighting its benefits and value. The aim of this study was to assess the efficacy, complications, and impact on fertility and future pregnancies of Pereira’s suture applied in cases of uterine atony and postpartum hemorrhage.
Methods: An observational retrospective study was performed by consulting the medical records of women treated with Pereira’s compressive sutures in a tertiary center between January 2013 and December 2022. We registered demographic data, pregnancy outcomes, short-term complications, and outcomes of subsequent pregnancies.
Results: A total of 50 women were treated with Pereira’s suture. The overall success rate was 96% and no hysterectomies were performed. Women who had sutures performed during an intra-cesarean section had better outcomes than those who had an after-cesarean section. Complications were reported in 12% (n = 6) of women, with the most frequent being pelvic infection (n = 3) and abdominal pain (n = 3). Regarding fertility, all women desiring a future pregnancy (n = 5) were able to conceive, resulting in three live births.
Conclusion: Pereira’s suture is a type of suture that provides numerous advantages and should be considered when first-line medical treatment fails. When applied at an early stage, the sutures may prevent maternal morbidity. The Alcides Pereira’s suture is a safe technique and appears to preserve fertility.

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References

World Health Organization. WHO postpartum haemorrhage (PPH) summit. 2022. [cited 2023 Feb 06]. Available from: https://www.who.int/publications/m/item/who-postpartum-haemorrhage-(pph)-summit.

The American College of Obstetricians and Gynecologists. Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet Gynecol. 2017;130:e168-86. DOI: https://doi.org/10.1097/AOG.0000000000002351

Nagahama G, Korkes HA, Sass N. Clinical experience over 15 years with the b-lynch compression suture technique in the management of postpartum hemorrhage. Rev Bras Ginec Obst. 2021;43:655-61. DOI: https://doi.org/10.1055/s-0041-1735228

Pereira A, Nunes F, Pedroso S, Saraiva J, Retto H, Meirinho M. Compressive uterine sutures to treat postpartum bleeding secondary to uterine atony. Obstet Gynecol. 2005;106:569-72. DOI: https://doi.org/10.1097/01.AOG.0000168434.28222.d3

Stein W, Hawighorst T, Emons G. Die operative Behandlung von schweren atonischen Nachblutungen mit Uterus-Kompressionsnähten in Anlehnung an Pereira. Z Geburtshilfe Neonatol. 2008;212:18-21. DOI: https://doi.org/10.1055/s-2008-1004687

Palacios-Jaraquemada JM. Efficacy of surgical techniques to control obstetric hemorrhage: analysis of 539 cases. Acta Obstetric Gynecolog Scand. 2011;90:1036-42. DOI: https://doi.org/10.1111/j.1600-0412.2011.01176.x

Setiyono AB, Aziz A, Sulistyono A, Mose JC. Pereira suture: an alternative compression suture to treat uterine atony. Indones J Obstet Gynecol. 2016;3:177-80. DOI: https://doi.org/10.32771/inajog.v3i3.50

Santos RR, Martins I, Clode N, Santo S. Uterine preservation with Alcides-Pereira’s compressive sutures for postpartum uterine atony. Eur J Obstet Gynecol Reprod Biol. 2022;277:27-31. DOI: https://doi.org/10.1016/j.ejogrb.2022.08.008

B-Lynch C, Coker A, Lawal AH, Abu J, Cowen MJ. The B-Lynch surgical technique for the control of massive postpartum haemorrhage: an alternative to hysterectomy? Five cases reported. BJOG. 1997;104:372-5. DOI: https://doi.org/10.1111/j.1471-0528.1997.tb11471.x

Cho J. Hemostatic suturing technique for uterine bleeding during cesarean delivery. Obstet Gynecol. 2000;96:129-31. DOI: https://doi.org/10.1016/S0029-7844(00)00852-8

Hayman R. Uterine compression sutures: surgical management of postpartum hemorrhage. Obstet Gynecol. 2002;99:502-6. DOI: https://doi.org/10.1016/S0029-7844(01)01643-X

Fotopoulou C, Dudenhausen JW. Uterine compression sutures for preserving fertility in severe postpartum haemorrhage: an overview 13 years after the first description. J Obstet Gynaecol. 2010;30:339-49. DOI: https://doi.org/10.3109/01443611003650233

Kayem G, Kurinczuk J, Alfirevic Z, Spark P, Brocklehurst P, Knight M. Specific second-line therapies for postpartum haemorrhage: a national cohort study. BJOG. 2011;118:856-64. DOI: https://doi.org/10.1111/j.1471-0528.2011.02921.x

Matsubara S, Yano H, Ohkuchi A, Kuwata T, Usui R, Suzuki M. Uterine compression sutures for postpartum hemorrhage: an overview. Acta Obstet Gynecol Scand. 2013;92:378-85.

Subbaiah M, Chaturvedula L, Kubera NS, Raj A. Subsequent pregnancy outcome after uterine compression suture placement for postpartum hemorrhage. Int J Gynecol Obstet. 2021;156:475-80.

Doumouchtsis S, Nikolopoulos K, Talaulikar V, Krishna A, Arulkumaran S. Menstrual and fertility outcomes following the surgical management of postpartum haemorrhage: a systematic review. BJOG. 2013;121:382-8. DOI: https://doi.org/10.1111/1471-0528.12546

Sathe NA, Likis FE, Young JL, Morgans A, Carlson-Bremer D, Andrews J. Procedures and uterine-sparing surgeries for managing postpartum hemorrhage. Obstet Gynecol Surv. 2016;71:99-113. DOI: https://doi.org/10.1097/OGX.0000000000000273

Moleiro ML, Braga J, Machado MJ, Guedes-Martins L. Uterine compression sutures in controlling postpartum haemorrhage: a narrative review. Acta Med Port. 2022;35:51-8. DOI: https://doi.org/10.20344/amp.11987

Mallappa Saroja CS, Nankani A, El-Hamamy E. Uterine compression sutures, an update: review of efficacy, safety and complications of B-Lynch suture and other uterine compression techniques for postpartum haemorrhage. Arch Gynecol Obstet. 2009;281:581-8. DOI: https://doi.org/10.1007/s00404-009-1249-z

Poujade O, Grossetti A, Mougel L, Ceccaldi P, Ducarme G, Luton D. Risk of synechiae following uterine compression sutures in the management of major postpartum haemorrhage. BJOG. 2010;118:433-9. DOI: https://doi.org/10.1111/j.1471-0528.2010.02817.x

Takahashi H, Baba Y, Usui R, Suzuki H, Horie K, Yano H, et al. Matsubara–Yano suture: a simple uterine compression suture for postpartum hemorrhage during cesarean section. Arch Gynecol Obstet. 2018;299:113-21. DOI: https://doi.org/10.1007/s00404-018-4947-6

D Dadhwal V, Sumana G, Mittal S. Hematometra following uterine compression sutures. Int J Gynecol Obstet. 2007;99:255-6. DOI: https://doi.org/10.1016/j.ijgo.2007.05.038

Subbaiah M, Chaturvedula L, Kubera NS, Raj A. Subsequent pregnancy outcome after uterine compression suture placement for postpartum hemorrhage. Int J Gynecol Obstet. 2021;156:475-80. DOI: https://doi.org/10.1002/ijgo.13710

Baskett T. Uterine compression sutures for postpartum hemorrhage: efficacy, morbidity, and subsequent pregnancy. Obstet Gynecol. 2008;28:11-2. DOI: https://doi.org/10.1097/01.aoa.0000308291.76037.2d

Begum J, Pallave P, Ghose S. B-Lynch: a technique for uterine conservation or deformation? A case report with literature review. J Clin Diagn Res. 2014;8:1-3. DOI: https://doi.org/10.7860/JCDR/2014/8139.4284

Wu HH, Yeh GP. Uterine cavity synechiae after hemostatic square suturing technique. Obstet Gynecol. 2005;105:1176-8. DOI: https://doi.org/10.1097/01.AOG.0000159978.26472.a4

Treloar E, Anderson R, Andrews H, Bailey J. Uterine necrosis following B-Lynch suture for primary postpartum haemorrhage. BJOG. 2006;113:486-8. DOI: https://doi.org/10.1111/j.1471-0528.2006.00890.x

Akoury H, Sherman C. Uterine wall partial thickness necrosis following combined b-lynch and cho square sutures for the treatment of primary postpartum hemorrhage. J Obstet Gynaecol Can. 2008;30:421-4. DOI: https://doi.org/10.1016/S1701-2163(16)32827-4

Gottlieb AG, Pandipati S, Davis KM, Gibbs RS. Uterine necrosis. Obstet Gynecol. 2008;112:429-31. DOI: https://doi.org/10.1097/AOG.0b013e31817b0781

Archana C, Rashmi M, Amita S. Early uterine necrosis due to modified b-lynch suture. J Obstet Gynecol India. 2021;72:95-7. DOI: https://doi.org/10.1007/s13224-020-01393-7

Rathat G, Do Trinh P, Mercier G, Reyftmann L, Dechanet C, Boulot P, et al. Synechia after uterine compression sutures. Fertil Steril. 2011;95:405-9. DOI: https://doi.org/10.1016/j.fertnstert.2010.08.055

An GH, Ryu HM, Kim MY, Han JY, Chung JH, Kim MH. Outcomes of subsequent pregnancies after uterine compression sutures for postpartum hemorrhage. Obstet Gynecol. 2013;122:565-70. DOI: https://doi.org/10.1097/AOG.0b013e31829e3b1d

Amorim-Costa C, Mota R, Rebelo C, Silva PT. Uterine compression sutures for postpartum hemorrhage: is routine postoperative cavity evaluation needed? Acta Obstet Gynecol Scand. 2011;90:701-6. DOI: https://doi.org/10.1111/j.1600-0412.2011.01137.x

Matsubara S, Yano H, Ohkuchi A, Kuwata T, Usui R, Suzuki M. Uterine compression sutures for postpartum hemorrhage: an overview. Acta Obstet Gynecol Scand. 2013;92:378-85. DOI: https://doi.org/10.1111/aogs.12077

Van den Brink JW, Samlal RA. Pregnancy after ligation of the hypogastric artery combined with a B-Lynch brace suture for major postpartum haemorrhage: a case with a nearly fatal outcome. Eur J Obstet Gynecol Reprod Biol. 2009;144:187-8. DOI: https://doi.org/10.1016/j.ejogrb.2009.03.005

Pechtor K, Richards B, Paterson H. Antenatal catastrophic uterine rupture at 32 weeks of gestation after previous B-Lynch suture. BJOG. 2010;117:889-91. DOI: https://doi.org/10.1111/j.1471-0528.2010.02554.x

Amarasekara S, Dissanayake D, Jayawardana A, Silva D. Uterine rupture at 33 weeks following previous B-Lynch suture. Ceylon Med J. 2011;56:121. DOI: https://doi.org/10.4038/cmj.v56i3.3606

Alouini S, Coly S, Mégier P, Lemaire B, Mesnard L, Desroches A. Multiple square sutures for postpartum hemorrhage: results and hysteroscopic assessment. Am J Obstet Gynecol. 2011;205:335.e1-6. DOI: https://doi.org/10.1016/j.ajog.2011.05.006

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Published

2024-03-06

How to Cite

1.
Cordeiro Féria B, Nazaré P, Figueiredo J, Neves Gomes I, Pereira A. Efficacy, Complications and Effects of Alcides Pereira’s Sutures in the Management of Uterine Atony: A Retrospective Study. Acta Med Port [Internet]. 2024 Mar. 6 [cited 2024 Jul. 24];37(7-8):518-25. Available from: https://actamedicaportuguesa.com/revista/index.php/amp/article/view/20429