’Quilting Sutures’ for the Prevention of Hysterectomy in Women with Postpartum Hemorrhage
BACKGROUND AND PURPOSE:
‘Quilting sutures’, a backstitch quilting technique, was first performed in 2007 and reported in 2012
Stein et al. (International Journal of Obstetrics & Gynaecology, 2018) determined whether “quilting” sutures are safe and effective for preventing hysterectomy among women with postpartum hemorrhage (PPH)
The authors describe suture technique as follows (see YouTube Video in ‘Primary Sources – Learn More’ section, below)
Starting at the top of the uterus continuing down to the cervical segment, horizontally placed U-sutures were used to fix the anterior to the posterior wall. Up to 12 size 1 absorbable sutures (Vicryl) were applied to compress the uterus completely.
Sutures placed in women with PPH following cesarean section and administration of uterotonics
Objective and subjective data were collected by analyzing medical records and performing telephone interviews (2007 to 2016)
Trends were also analyzed by comparing
Women in the first 50%
Women in the second 50% (use of quilting sutures were more common and used immediately after failure of medical treatment, prior to massive blood loss)
26 cesarean sections using quilting sutures were performed more frequently over time
8 sutures performed during 2007-2011 (first 5-year period)
18 sutures performed during 2012–2106 (second 5-year period)
Characteristics, overall, between the first 13 women were similar to the second cohort of 13 women
First group had more inductions (7 vs 2)
More women in the first 50% group had manual compression, indicating use of other techniques prior to quilting sutures compared to the latter 50%
Comparing the first 50% of women to the 2nd 50%
Intensive care: Was more frequent in the first 13 procedures (10 women) vs second 13 procedures (5 women)
Blood transfusion: Was more frequent in the first 13 procedures (9 women) vs second 13 procedures (4 women)
Three women who desired to have a child subsequently delivered a newborn
Menses restarted by 7 weeks postpartum (for women not on hormonal contraceptives)
One women reported amenorrhea
Therapeutic anticoagulation following pulmonary embolism
Quilting suture failure: PPH could not be controlled
Authors acknowledge small sample size and lack of prospective data
Quilting sutures were a safe and efficient prevention of hysterectomies in PPH
Less tissue is compressed compared to other techniques such as B-Lynch
The authors state
…horizontal application of U-stiches, which facilitates optimal oxygenation from both arteriae uterinae
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This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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