The Clinical Application Of Modified U-suturing Technique For Intractable Postpartum Hemorrhage

Objective This study to explore the possible high-risk factors for intractable postpartum hemorrhage,and evaluate the effectiveness and prognosis of a modified U-suturing technique with intractable postpartum hemorrhage after Cesarean section.Methods From January 2013 to March 2016,totally 42 cases of intractable postpartum hemorrhage maternal with cesarean section(postpartum hemorrhage group)and 126cases of non-postpartum hemorrhage maternal with cesarean section who were selected according to 1:3 randomly(normal group)were admitted in the Department of Obstetrics,Qi Lu Hospital of Shandong University,and the clinical data were analyzed retrospectively.The active bleeding stopped after the modified U-suturing technique was implemented in the ten cases who were firstly treated with uterus massage,contraction drugs,intrauterine packing,uterine artery ligation,B-Lynch suturing and/or "8" suturing but to no available(suturing group),and 32 cases of intractable postpartum hemorrhage without the modified U-suturing technique(conventional group).The data was analyzed in the chi-square test and non-rank-sum test using SPSS 23.0 statistical software.Results1,By comparing the intractable postpartum hemorrhage group with normal group,the high-risk factors for intractable postpartum hemorrhage were recognized,including the maternalage,history of abortion,multiple pregnancy and cesarean section.2,Suture group of placental factors of intractable postpartum hemorrhage in 6 cases(60%),conventional group 28 cases placental factors of intractable postpartum hemorrhage(87.5%),two groups had no coagulant function abnormality,two groups of bleeding reason no statistical difference(P>0.05).3,The amount of bleeding,blood transfusion,the operation time and the amount of days of hospitalization of the suturing group were 2250.00±716.86ml,6.20±3.19U,138,50±35.28min and 4.50±1.96d respectively.while the counterpart in conventional group were 3510.00+1877.70ml,12.4±9.46U,139.40±69.29min and 7.37±2.61dmin respectively.There was statistical significance when P<0.05.4,The treatment of ten patients of the suturing group was successful,the hemorrhage was controlled and the uterus preserved,and there were six cases of the conventional group undergo hysterectomy.5,Normal menstruation patterns returned and no surgery related morbidities were noted at the follow-up examinations of ten patients.Among the ten patients,there were two patients pregnant again,and there was one patient has delivery,and the other was abortion.Conclusions The complications caused by intractable postpartum hemorrhage was one of the reasons that lead to maternal mortality.Elderly parturient women,the abortion history,prolific,and cesarean section what were the high-risk factors of intractable postpartum hemorrhage should be alert.Uterine compression with U-sutures is a highly effective and simple procedure which conserves the uterus in these patients,and the U-suture technique we describe here was developed for use in emergency situations.