Case report on resistant postpartum hemorrhage during cesarean section treated with a modified quadruple uterine belt suture technique for uterus preservation

BACKGROUND: Severe postpartum hemorrhage during cesarean section is a critical obstetric emergency; delayed hemostasis may lead to hemorrhagic shock, hysterectomy, and even maternal mortality. Individualized uterine-preserving hemostatic strategies represent the central focus and greatest challenge in current clinical management. CASE PRESENTATION: This article reports a case of a patient at 40 + 2 weeks of gestation with concurrent gestational diabetes mellitus and prenatal fever. During cesarean section, the patient developed severe postpartum hemorrhage (with blood loss reaching 2,500 mL) due to complete dense adhesion between placenta and membranes, partial placental implantation on the posterior uterine wall, extensive intrauterine adhesions with pseudocyst formation, and uterine atony. Despite multiple hemostatic measures-including manual placental detachment, forceps removal of implanted tissue, suture closure with braided sutures, administration of uterotonic agents, ligation of bilateral ascending uterine arteries, local figure-of-eight sutures, and intrauterine gauze packing-all proved ineffective. Emergency quadruple modified uterine belt suturing was subsequently performed, successfully preserving the uterus. Postoperatively, multidisciplinary comprehensive management was implemented, encompassing anti-infection therapy, antithrombotic treatment, prevention of uterine necrosis, and correction of anemia and hypoalbuminemia, effectively preventing complications such as infection, uterine necrosis, and venous thrombosis. Follow-up imaging at 3 months showed no abnormalities, with favorable outcomes for both mother and fetus. This study delineates key procedural principles for this technique, providing a reproducible emergency management protocol for clinical practice. CONCLUSIONS: The quadruple modified uterine dorsal suture technique represents a variant of traditional compression suturing, enabling uniform compression of the entire uterine segment and rapid hemostasis. Combined with multimodal interventions, it effectively addresses refractory postpartum hemorrhage of complex etiology. Strict control of suture tension and postoperative dynamic monitoring can balance the benefits of uterine preservation with surgical risks.