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)

METHODS:

• Retrospective study
• 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)

RESULTS:

• 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 2^nd 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
• 2 hysterectomies
  • Therapeutic anticoagulation following pulmonary embolism
  • Quilting suture failure: PPH could not be controlled

CONCLUSION:

• 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

Learn More – Primary Sources:

Effect of early “quilting” sutures on morbidity in postpartum hemorrhage

Video: Quilting Suture Technique for PPH

“Quilting” sutures to prevent hysterectomy in patients with postpartum hemorrhage

Related ObG Topics:

Postpartum Hemorrhage – Medications to Treat Uterine Atony 

How Effective is Intrauterine Balloon Tamponade for Severe Postpartum Hemorrhage

Heat Stable Carbetocin: A Heat-Stable Alternative to Oxytocin?

Latest Cochrane Review: What is the Most Effective Prophylactic Treatment for Postpartum Hemorrhage?