Uterine necrosis following hemostatic compression suture: case report and review of the literature
DOI:
https://doi.org/10.18597/rcog.3856Keywords:
Cesarean section, postpartum hemorrhage, necrosis, suture techniques, uterusAbstract
Objectives: To present a case of uterine necrosis following hemostatic suturing to control postpartum bleeding, and to review the literature in order to identify the suture techniques employed, clinical findings, diagnostics and treatment in the clinical cases described.
Materials and Methods: A 34-year-old woman presenting with abdominal pain eight days after cesarean delivery due to placenta previa who required B-Lynch compression suture due to uterine atony, and who was diagnosed with uterine necrosis. The patient underwent total abdominal hysterectomy with a satisfactory recovery. A systematic literature search was conducted in the Medline vía Pubmed, Embase and Web of Science databases. The search included case series and reports, and cohorts of women with uterine necrosis following the use of uterine compression sutures for postpartum bleeding. The analysis included sociodemographic and clinical variables at the time of diagnosis, suturing technique, diagnostic tests and treatment.
Results: Overall, 23 studies with 24 patients were included. Of all necrosis cases, 83% occurred following cesarean section. B-Lynch was the suturing technique most frequently used (66 %), followed by the Cho suture (25 %). The most frequent symptoms were fever and abdominal pain. The most commonly used diagnostic test was computed tomography (9/24 cases). Hysterectomy was performed in the majority of cases (75 %).
Conclusions: Although rare, uterine wall necrosis is a serious complication. It would be advisable to design follow-up cohort studies of women undergoing these procedures in order to determine the incidence of associated complications.
Author Biographies
Raquel García-Guerra, Hospital Universitario de Getafe, Madrid (España).
Especialista en Ginecología y Obstetricia, Hospital Universitario de Getafe, Madrid (España).
Myrna Assaf-Balut, Hospital Universitario de Getafe, Madrid (España).
Residente de Ginecología y Obstetricia, Hospital Universitario de Getafe, Madrid (España).
Sara El-Bakkali, Hospital Universitario Ibn Sina, Rabat (Marruecos).
Especialista en Ginecología y Obstetricia, Hospital Universitario Ibn Sina, Rabat (Marruecos).
Irene Pérez de Ávila-Benavides, Hospital Universitario de Getafe, Madrid (España).
Jefa de sección de Ginecología y Obstetricia, Hospital Universitario de Getafe, Madrid (España).
Miguel Ángel Huertas-Fernández, Hospital Universitario de Getafe, Madrid (España).
Jefe de servicio de Ginecología y Obstetricia, Hospital Universitario de Getafe, Madrid (España).
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