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Technique Often Useful
Dr. Carolyn Zelop said that this study has important implications for practice. “I think the take-home message … is that [the use of compression sutures] is a very reliable technique, but that it's probably less useful in the setting of placenta accreta,” explaining that uterine atony appears to be the indication that leads to the most success with this technique.
Another important point made by the authors is that in the setting of vaginal delivery that is complicated by postpartum hemorrhage, it is important to “be on the clock and ready to move to the next intervention,” since a delay of 2–6 hours in suture placement was associated with increased risk of hysterectomy.
Although it seems logical that a clinician might be reluctant to proceed with laparotomy after vaginal delivery, a prolonged delay could predispose a patient to unrecognized blood loss, and increase the risk of compression suture failure. If mechanical tamponade techniques fail to control hemorrhaging, the clinician should proceed with laparotomy and uterine compression suture placement, she advised.
Vitals
DR. ZELOP is director of maternal-fetal medicine at Beth Israel Deaconess Medical Center in Boston. She said she had no relevant financial disclosures.