Fahmy's four quadrant sutures: a new technique for control of blood loss during cesarean delivery for placenta previa

Authors

  • Mohamed S. Fahmy Department of Obstetrics and Gynecology, Faculty of Medicine, Aswan University, Egypt
  • Laila Ezzat Department of Obstetrics and Gynecology, Faculty of Medicine, Aswan University, Egypt
  • Maraey M. Khalil Department of Obstetrics and Gynecology, Faculty of Medicine, Aswan University, Egypt
  • Ahmed H. Elsayed Department of Obstetrics and Gynecology, Faculty of Medicine, Aswan University, Egypt
  • Sherif S. Fahmy Department of Obstetrics and Gynecology, Faculty of Medicine, Aswan University, Egypt
  • Adham Badawy Department of Obstetrics and Gynecology, Faculty of Medicine, Aswan University, Egypt
  • Hossam Ramadan Department of Obstetrics and Gynecology, Faculty of Medicine, Aswan University, Egypt
  • Ahmed M. Abbas Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20183291

Keywords:

Cesarean delivery, Placenta previa, Postpartum hemorrhage

Abstract

Background: The objective of this study is to assess the efficacy and safety of Fahmy's four quadrant suture technique (FFQS) in controlling blood loss during cesarean delivery for placenta previa (PP).

Methods: The study was carried out in a tertiary University Hospital between January 2017 to December 2017 involved 12 women with heavy bleeding occurred after removal of the placenta from the lower section during cesarean delivery for PP. The FFQS technique consisted of two sutures to ligate the uterine branches on both sides and two sutures on the anterior and posterior wall of the lower uterine segment. Details regarding the management and maternal outcomes were recorded.

Results: The mean age of the study participants was 29.58±5.29 years and the mean parity was 2.25±1.14. The mean gestational age at termination of pregnancy was 36.91±1.38 weeks.  The mean duration of the whole surgery was 78.75±43.28 minutes, while the mean duration of FFQS technique was only 10±2.09 minutes. The technique was exclusively effective in 8 out of 12 cases (66.67%) while 2 cases needed bilateral internal iliac artery ligation and 2 cases needed hysterectomy. The mean amount of blood loss in all cases was 2433.33±833.76 ml. the mean amount of transfused packed RBCs was 3.92±1.68 units and fresh frozen plasma (FFP) was 3.42±1.44 units. All cases had uneventful postoperative course and no mortality cases in present series.

Conclusions: The new technique; FFQS represents a rapid, effective, and inexpensive opportunity for women with bleeding from the lower segment of uterus due to PP. This simple procedure should be attempted before other complex measures to achieve good hemostasis.

References

Devine PC, Wright JD. Obstetric hemorrhage. Introduction. Semin Perinatol. 2009;33(2):75.

Abbas AM, Amin MT, Ali SS, Salem NZ. Maternal mortality: a tertiary care hospital experience in Upper Egypt. Int J Reprod Contracept Obstet Gynecol. 2016;5(5):1466-71.

Fan D, Xia Q, Liu L, Wu S, Tian G, Wang W, et al. The incidence of postpartum hemorrhage in pregnant women with placenta previa: a systematic review and meta-analysis. PLoS One. 2017;12(1):e0170194.

Law LW, Chor CM, Leung TY. Use of hemostatic gel in postpartum hemorrhage due to placenta previa. Obstet Gynecol. 2010;116 Suppl 2:528-30.

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(3):372-5.

Hayman RG, Arulkumaran S, Steer PJ. Uterine compression sutures: surgical management of postpartum hemorrhage. Obstet Gynecol. 2002;99(3):502-6.

Cho JH, Jun HS, Lee CN. Hemostatic suturing technique for uterine bleeding during cesarean delivery. Obstet Gynecol. 2000;96(1):129-31.

Ali MK, Badee AY, Abbas AM, Shazly SA. A novel technique for modified B-Lynch suture for the control of atonic postpartum haemorrhage. Aust N Z J Obstet Gynaecol. 2013;53:94-7.

Abbas AM, Sheha AM, Ali MK, Khalaf M, Gamal E. Successful term delivery after Khairy’s modified B-lynch suture technique: first case report. Middle East Fertil Soc J. 2017;22(1):87-90.

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. 2010;281(4):581-8.

Gronvall M, Tikkanen M, Tallberg E, Paavonen J, Stefanovic V. Use of Bakri balloon tamponade in the treatment of postpartum hemorrhage: a series of 50 cases from a tertiary teaching hospital. Acta Obstet Gynecol Scand. 2013;92(4):433-8.

Ali MK, Abbas AM, Abdelbadee AY, Shazly SA, AbdelMagied AM. Use of Foley’s catheter balloon tamponade to control placental site bleeding resulting from major placenta previa during cesarean section. Proc Obstet Gynecol. 2016;6(3):4.

Dedes I, Ziogas V. Circular isthmic-cervical sutures can be an alternative method to control peripartum haemorrhage during caesarean section for placenta praevia accreta. Arch Gynecol Obstet. 2008;278(6):555-7.

Ying H, Duan T, Bao YR, Song YH, Wang DF. Transverse annular compression sutures in the lower uterine segment to control postpartum hemorrhage at cesarean delivery for complete placenta previa. Int J Gynaecol Obstet. 2010;108(3):247-8.

Penotti M, Vercellini P, Bolis G, Fedele L. Compressive suture of the lower uterine segment for the treatment of postpartum hemorrhage due to complete placenta previa: a preliminary study. Gynecol Obstet Investigation. 2012;73(4):314-20.

Shazly SA, Badee AY, Ali MK. The use of multiple 8 compression suturing as a novel procedure to preserve fertility in patients with placenta accreta: case series. The A N Z J Obstet Gynaecol. 2012; 52(4):395-9.

Zhu L, Zhang Z, Wang H, Zhao J, He X, Lu J. A modified suture technique for hemorrhage during cesarean delivery complicated by complete placenta previa. Int J Gynaecol Obstet. 2015;129(1):26-9.

Kumru P, Demirci O, Erdogdu E, Arisoy R, Ertekin AA, Tugrul S, et al. The Bakri balloon for the management of postpartum hemorrhage in cases with placenta previa. European J Obstet Gynecol Reprod Biol. 2013;167(2):167-70.

Zheng J, Xiong X, Ma Q, Zhang X, Li M. A new uterine compression suture for postpartum haemorrhage with atony. BJOG. 2011;118(3):370-4.

Portilla D, Hernandez-Giraldo C, Moreno B, Quijano F, Hoyos LR, Angarita AM, et al. A local hemostatic agent for the management of postpartum hemorrhage due to placenta previa and placenta accreta: a cross-sectional study. Arch Gynecol Obstet. 2013;288(3):543-9.

Fuglsang K, Dueholm M, Staehr-Hansen E, Petersen LK. Uterine healing after therapeutic intrauterine administration of Tacho Sil (hemostatic fleece) in cesarean section with postpartum hemorrhage caused by placenta previa. J Pregnancy. 2012;2012:635683.

Mitwaly AA, Abbas AM. Sequential surgical steps for conservative management of morbidly adherent placenta: case series, Thai J Obstet Gynecol. 2016;24:136-40.

Xiao JP, Zhang B. Combination of B-lynch and modified Cho sutures for postpartum hemorrhage caused by low-lying placenta and placenta accreta. Clinic Exp Obstet Gynecol. 2011;38(3):274-5.

Kaplanoglu M. The uterine sandwich method for placenta previa accreta in mullerian anomaly: combining the B-lynch compression suture and an intrauterine gauze tampon. Case Reports Obstet Gynecol. 2013;2013:236069.

Karateke A, Kucukbas M, Sozen H, Namazov A, Cakir S, Akdemir Y. Fertility sparing surgery on placenta invasion anomalies and placenta previa. Iranian J Reprod Med. 2012;10(3):271-4.

Koyama E, Naruse K, Shigetomi H, Sado T, Oi H, Kobayashi H. Combination of B-Lynch brace suture and uterine artery embolization for atonic bleeding after cesarean section in a patient with placenta previa accreta. J Obstet Gynaecol Res. 2012;38(1):345-8.

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Published

2018-07-26

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Original Research Articles