Effectiveness of compression of myometrium and occlusion of uterine artery by COMOC-MG suture in management of atonic postpartum hemorrhage

Authors

  • Trupangi J. Chaudhari Department of Obstetrics and Gynaecology, Gujrat Adani Institute of Medical Sciences Bhuj, Kutchh, Gujrat, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20240797

Keywords:

Atony, Cesarean, COMOC-MG suture, Maternal, PPH

Abstract

Background: Postpartum haemorrhage (PPH) remains a significant cause of maternal morbidity and mortality globally, with uterine atony being a primary etiological factor. This prospective interventional study aimed to assess the effectiveness of the compression of myometrium and occlusion of uterine artery by COMOC-MG suture technique in managing atonic PPH.

Methods: A prospective study was conducted at GK general hospital, Bhuj, Gujarat, from December 2020 to July 2022. The study enrolled 100 pregnant women without identified risk factors undergoing complicated caesarean or vaginal deliveries. The COMOC-MG suture technique was employed for the study group, while the control group received standard atonic PPH management. Outcomes included success rates, blood transfusion needs, complications, and mortality.

Results: The study group (n=50) demonstrated comparable demographic characteristics to the control group. Notably, the COMOC-MG group exhibited higher success rates in normal (100%) and cesarean deliveries (95.3%) compared to the control group (72.7% and 60.7%, respectively). Lower blood transfusion needs (34% vs. 48%) and fewer complications were observed in the COMOC-MG group. Hemoglobin (Hb) levels on post-partum day 1 showed no significant difference.

Conclusions: The study suggests that COMOC-MG suture technique is effective in managing atonic PPH, showing superior success rates and potentially reducing blood transfusion needs. While further research, including larger trials, is warranted, these findings underscore promise of COMOC-MG as an innovative intervention in obstetric care, offering potential benefits in maternal outcomes. The observed safety profile supports its consideration in clinical practice.

References

Kumar N. Postpartum hemorrhage; a major killer of woman: review of current scenario. Obstet Gynecol Int J. 2016;4(4):130-4.

Rani PR, Begum J. Recent Advances in the Management of Major Postpartum Haemorrhage-A Review. J Clin Diagn Res. 2017;11(2):QE01-5.

World Health Organization. WHO Postpartum Haemorrhage Summit. 2023. Available at: https://www.who.int/news-room/events/detail/2023/03/07/default-calendar/who-postpartum-haemorrhage summit#:~:text=Postpartum%20haemorrhage%20(PPH)%3A%20a,about%2070%2C000%20maternal%20deaths%20globally. Accessed on 10 February, 2024.

Ononge S, Mirembe F, Wandabwa J, Campbell OMR. Incidence and risk factors for postpartum hemorrhage in Uganda. Reprod Health. 2016;13:38.

Anderson J, Etches D. Prevention and Management of Postpartum Hemorrhage. Am Family Physician. 2007;75(6):875-82.

Pereira A, Nunes F, Pedroso S, Saraiva J, Retto H, Meirinho M. Compressive Uterine Sutures to Treat Postpartum Bleeding Secondary to Uterine Atony. Obstetr Gynecol. 2005;106(3):569-72.

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.

Evidence-based Practice Center Systematic Review Protocol. Project Title: Management of Postpartum Hemorrhage. Source: www.effectivehealthcare.ahrq.gov. 2014. Available at: https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/hemorrhage-postpartum_research-protocol.pdf. Accessed on 10 February, 2024.

Weisbrod AB, Sheppard FR, Chernofsky MR, Blankenship CL, Gage F, Wind G, et al. Emergent management of postpartum hemorrhage for the general and acute care surgeon. World J Emerg Surg. 2009;4:43.

Halle-Ekane GE, Emade FK, Bechem NN, Palle NJ, Fongaing D, Essome H, et al. Prevalence and Risk Factors of Primary Postpartum Hemorrhage after Vaginal Deliveries in the Bonassama District Hospital, Cameroon. IJTDH. 2015;13(2):1-12.

Guasch E, Gilsanz F. Massive obstetric hemorrhage: Current approach to management. Med Intensiva. 2016;40(5):298-310.

Lazo-Sacta OP, Mesa-Cano IC, Ramírez-Coronel AA, Jaimes-Carmona Y del C. Demographic and clinical characteristics in postpartum women with postpartum hemorrhage at Hospital José Félix Valdiviezo. Prosciences. 2021;5(41):257-69.

Lazo-Sacta OP, Mesa-Cano IC, Ramírez-Coronel AA, Jaimes-Carmona YC. Demographic and clinical characteristics in postpartum women with postpartum hemorrhage at Hospital José Félix Valdiviezo. Pro Sciences: Revista De Producción, Ciencias E Investigación. 2021;5(41):257-69.

Hackethal A, Brueggmann D, Oehmke F, Tinneberg HR, Zygmunt MT, Muenstedt K. Uterine compression U-sutures in primary postpartum hemorrhage after Cesarean section: fertility preservation with a simple and effective technique. Hum Reprod. 2008;23(1):74-9.

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

Kayem G, Kurinczuk JJ, Alfirevic Z, Spark P, Brocklehurst P, Knight M. Obstetric Surveillance System (UKOSS). Uterine compression sutures for the management of severe postpartum hemorrhage. Obstet Gynecol. 2011;117(1):14-20.

El-Sokkary M, Wahba K, El-Shahawy Y. Uterine salvage management for atonic postpartum hemorrhage using "modified lynch suture". BMC Pregnancy Childbirth. 2016;16(1):251.

Balki M, Dhumne S, Kasodekar S, Carvalho JCA, Seaward G. Blood transfusion for primary postpartum hemorrhage: a tertiary care hospital review. J Obstet Gynaecol Can. 2008;30(11):1002-7.

Ghosh SB, Mala YM. Alternate Sequential Suture Tightening: A Novel Technique for Uncontrolled Postpartum Hemorrhage. Obstetr Gynecol Int. 2015;145178:6.

Jansen AJ, Van Rhenen DJ, Steegers EA, Duvekot JJ. Postpartum hemorrhage and transfusion of blood and blood components. Obstet Gynecol Surv. 2005;60(10):663-71.

Ochiai D, Abe Y, Yamazaki R, Uemura T, Toriumi A, Matsuhashi H, et al. Clinical Results of a Massive Blood Transfusion Protocol for Postpartum Hemorrhage in a University Hospital in Japan: A Retrospective Study. Medicina. 2021;57:983.

Davey MA, Flood M, Pollock W, Cullinane F, McDonald S. Risk factors for severe postpartum haemorrhage: A population-based retrospective cohort study. Aust N Z J Obstet Gynaecol. 2020;60(4):522-32.

Fong A, Leake J, Pan D, Ogunyemi D. Demographic, institutional and obstetrical risk factors for postpartum haemorrhage mortality. J Obstet Gynaecol. 2010;30(5):470-5.

Amanuel T, Dache A, Dona A. Postpartum Hemorrhage and its Associated Factors Among Women Who Gave Birth at Yirgalem General Hospital, Sidama Regional State, Ethiopia. Health Serv Res Manag Epidemiol. 2021;8:23333928211062777.

Duhan L, Nanda S, Sirohiwal D, Dahiya P, Singhal S, Vandana. A retrospective study of maternal and perinatal outcome in patients of postpartum haemorrhage in a tertiary care hospital. Int J Reprod Contracept Obstet Gynecol. 2016;5:1897-901.

Marasinghe JP, Condous G, Seneviratne HR, Marasinghe U. Modified anchored B-Lynch uterine compression suture for post-partum bleeding with uterine atony. Acta Obstetricia et Gynecologica Scandinavica. 2011;90:280-83.

Kaoiean S. Successful use of the B-Lynch uterine compression suture in treating intractable postpartum hemorrhage after cesarean delivery in Rajavithi Hospital. J Med Assoc Thai. 2013;96(11):1408-15.

Downloads

Published

2024-03-28

Issue

Section

Original Research Articles