The compression of myometrium and occlusion of uterine artery by COMOC-MG technique for the management of postpartum haemorrhage: clinical perspective from ten cases

Authors

  • Jitendra Prajapati Department of IVF, Shrushti Test Tube Baby Centre, Mehsana, Gujarat, India
  • Abhishek Oza Department of Obstetrics and Gynecology, Nikta Women’s Hospital, Mehsana, Gujarat, India
  • Mahesh Gupta Department of Obstetrics and Gynecology, Pushpam and Matis Hospital, Ahmedabad, Gujarat, India
  • Ketan Kulkarni Department of Medical Services, Emcure Pharmaceuticals Ltd., Pune, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20240806

Keywords:

COMOC-MG, Postpartum hemorrhage, Polyglycolic acid suture, Modified B-lynch technique

Abstract

Compression of myometrium and occlusion of uterine artery by Dr. Mahesh Gupta (COMOC-MG) technique is an improved B-lynch stitch technique used to control postpartum hemorrhage (PPH). Objective was to study clinical perspective of the COMOC-MG technique on the effect of PPH in Indian women. Data of 10 patients with PPH who were managed by using the COMOC-MG technique in a tertiary care center in Gujarat from April 2022 to December 2022 were retrieved. Baseline characteristics, medical problems and history of women were recorded. Decision to perform COMOC-MG stitch was taken based on the indications such as PPH, per vaginal bleeding and degree of uterine contractility. Out of 10 women, four women had medical problems such as pregnancy-induced hypertension, dysfunctional uterine bleeding and using psychiatric medicines; two women had uterine surgery/ Laparotomy; four women were diagnosed with ailments such as pregnancy induced hypertension (PIH) and hypertension during the third trimester of pregnancy. Indications such as twins during a previous pregnancy, deflexed head, previous lower segment caesarean section (LSCS) with intrauterine growth restriction (IUGR), breech, prim parity, severe oligohydramnios, placental insufficiency and second baby were considered to carry out the CS delivery. Women were managed by COMOC-MG stitch followed by Misoprostol tablets; Carbetocin, Oxytocin, Methylergometrine and Carboprost injections to control PPH. Mean time between uterine closure to COMOC-MG was 10 min. COMOC-MG stitch resulted in good outcomes in seven patients except one patient had atonic PPH. Out of ten patients, one patient required a hysterectomy and three patients required blood transfusion. COMOC-MG stitch is an easy, simple method to control PPH.

References

Wormer KC, Jamil RT, Bryant SB. Acute Postpartum Hemorrhage. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2024.

World Health Organization. Postpartum Haemorrhage Summit. 2023. Available at: https://www.who.int /news-room/events/detail/2023/03/07/default-calendar/who-postpartum-haemorrhage-summit. Accessed on 05 February 2024.

Maternal Health Division Ministry of Health and Family Welfare Government of India. Guidance Note on Prevention and Management of Postpartum Haemorrhage. 2015. Available at: https://nhm.gov.in/ images/pdf/programmes/maternal-health/guidelines/ Guidance_Note_on_Prevention_&_Management_of_Postpartum_Haemorrhage.pdf. Accessed on 05 February 2024.

Evensen A, Anderson JM, Fontaine P. Postpartum Hemorrhage: Prevention and Treatment. Am Fam Physician. 2017;95(7):442-9.

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. Br J Obstet Gynaecol. 1997;104(3):372-5.

Matsubara S, Yano H, Ohkuchi A, Kuwata T, Usui R, Suzuki M. Uterine compression sutures for postpartum hemorrhage: an overview. Acta Obstet Gynecol Scand. 2013;92(4):378-85.

Gupta M. COMOC-MG Stitch: Modification of B-lynch Suturing Technique to Control Atonic Post-partum Haemorrhage. J Obstet Gynaecol India. 2020;70(6):523-6.

Gani N, Ali T. Prevalence and factors associated with maternal postpartum haemorrhage in Khyber Agency, Pakistan J Ayub Med Coll Abbottabad. 2013;25(1):81-5.

Gupta M, Gupta A, Dadanbhai Otha D, Gupta U. Modification of B-lynch Stitch Technique (COMOC-MG) to Control Postpartum Hemorrhage: Clinical Perspective from 19 Cases. Pan Asian J Obstet Gynecol. 2020;3(2):98-102.

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Published

2024-03-28

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Case Series