Purse-String Compression Sutures at Cesarean Section: Its Role in Prevention of Primary Post-Partum Hemorrhage (PPH) In Port Harcourt

Abstract

Objective: To highlight the efficacy of a simple surgical procedure, during cesarean section in preventing primary postpartum hemorrhage in women who are predisposed to having it. Methods: After closure of the transverse lower segment incision on the uterus, the operator moves laterally to the left round ligament. An absorbable vicryl-2 suture on a round bodied needle is passed through the ligament, about 2 cm below the level of the uterine incision. The suture is knotted and passed through an avascular space in the adjacent broad ligament. The suture is then passed through the uterine wall at the level of the utero-cervical junction in a purse-string fashion posteriorly and continuing anteriorly under tension until it gets to the left round ligament (the starting point). The two edges of the suture are knotted together and cut about 1 cm from the knot. Result: One thousand and five (1005) patients had this procedure done between 2014-2020. Their mode of delivery was cesarean section, and all of them had predisposing factors to primary postpartum hemorrhage. 997 (99.2%) had blood loss of <1000 ml. Only 8 (0.79%) had intraoperative and post-operative blood loss >1000 ml. These were due to extensive cervical lacerations and co-agulation disorders. Conclusion: It is suggested that the reduced blood loss in these women who were predisposed, was as a result of the purse-string suture during cesarean section. Reduced incidence of primary postpartum hemorrhage results in reduced incidence of maternal death due to this cause.