Application of Uterine Compression Suture in Association with Intra-Uterine Balloon Tamponade in Post-Partum Hemorrhage

Abstract

Background: Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide, particularly in low-resource settings. Conservative surgical techniques such as uterine compression sutures and intrauterine balloon tamponade have emerged as effective alternatives to hysterectomy in managing severe PPH. This study explores the combined application of these methods to assess their efficacy in preserving the uterus and improving maternal outcomes. Objective: This study aimed to assess the effectiveness of combining uterine compression sutures with intrauterine balloon tamponade in the management of postpartum hemorrhage (PPH). Methodology: A cross-sectional descriptive study was conducted over one year, beginning July 7, 2023, at the Department of Obstetrics & Gynecology, Peoples University of Medical and Health Sciences for Women, Nawabshah. Fifty women experiencing PPH unresponsive to uterotonics were enrolled through non-probability purposive sampling. All participants underwent a combination of uterine compression sutures (B-Lynch or Hayman) and intrauterine balloon tamponade. Data was collected using structured proformas and analyzed using SPSS version 25. Variables assessed included mode of delivery, cause of PPH, type of suture, balloon volume, blood loss, blood transfusion needs, postoperative complications, hysterectomy needs, and reproductive recovery outcomes. Statistical associations were examined using chi-square and ANOVA tests. Results: Of the 50 patients, 90% avoided hysterectomy, and 88% achieved full clinical recovery within three months. Return of menstruation was reported in 80%, and 85% had normal ultrasound findings at follow-up. Postoperative complications occurred in less than 30% of cases, with fever and infection being the most common. No statistically significant association was observed between mode of delivery and cause of PPH (p=0.404), nor between cause of PPH and balloon volume (p=0.725), though blood loss showed a near-significant trend with PPH etiology (p=0.058). B-Lynch sutures were more frequently used and associated with slightly lower blood loss. Conclusion: The uterine sandwich technique proved to be a highly effective, uterus-preserving option for managing refractory PPH, offering favorable outcomes with minimal complications. These findings support its wider implementation in clinical practice, particularly in low-resource settings where hysterectomy carries high physical, emotional, and reproductive burdens. The study highlights the importance of structured training in conservative surgical methods and the development of context-specific PPH protocols. Further multi-center research is recommended to validate these outcomes and explore long-term reproductive health implications, ensuring that maternal health strategies are both effective and sustainable.