Uterine Mesh Compression Suture: A Modified Therapeutic Approach for Refractory Postpartum Hemorrhage

Uterine Mesh Compression Suture: A Modified Therapeutic Approach for Refractory Postpartum Hemorrhage | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Uterine Mesh Compression Suture: A Modified Therapeutic Approach for Refractory Postpartum Hemorrhage Li Dan, Li Li, Xu Yang, Wang Chendi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6760232/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective : To investigate the application value of a novel suture technique—uterine mesh compression suture (UMCS)—in the management of refractory postpartum hemorrhage (PPH). Methods : A retrospective analysis was performed on 45 patients with refractory PPH who underwent UMCS, evaluating the surgical efficacy and safety. Clinical data, including hemostatic effect, postoperative complications, reproductive function outcomes, and long-term follow-up results, were systematically analyzed. Results : In all cases, active uterine bleeding ceased within 5–10 minutes after UMCS. Cumulative vaginal blood loss was <20 mL within 2 hours postoperatively, confirming effective hemostasis. Magnetic resonance imaging (MRI) on day 4 revealed no intrauterine effusion; Postoperative hormone assays showed all values within normal ranges at 5 days postoperatively; At 42 days postoperatively, both ultrasound and MRI demonstrated normal uterine structure without abnormalities. Hysteroscopic examination at 6 months showed no intrauterine adhesions, with clear patency of fallopian tube ostia. During follow-up, 45 patients resumed normal menstruation 1–2 months after stopping breastfeeding. Ten patients achieved subsequent pregnancy, including 4 who underwent repeat cesarean delivery and 6 who terminated pregnancy via induced abortion, with no reported complications related to the suture technique. Conclusion: UMCS effectively controls PPH caused by uterine atony. This technique is recommended for patients with refractory PPH due to uterine atony who fail traditional hemostatic measures, or for cases of intraoperative bleeding ≥1500 mL during cesarean section, where UMCS can be performed directly as a first-line intervention. Health sciences/Diseases Health sciences/Medical research Refractory postpartum hemorrhage Emergency obstetric care Uterine mesh compression suture Surgical efficacy Indications Figures Figure 1 Figure 2 Introduction Postpartum hemorrhage (PPH) remains the primary cause of maternal morbidity and mortality globally, accounting for 27% of all maternal deaths [1] . In 2020, the incidence of severe PPH in China was reported to be 0.96% [2] . Alarmingly, even in developed countries, the prevalence of PPH is increasing. For instance, in Australia over the past decade, PPH emerged as the leading cause of maternal mortality, with a rate of 4 deaths per 1 million live births [3] . The four major etiologies of PPH include uterine atony, birth canal trauma, placental abnormalities, and coagulation disorders [4] . When traditional treatments such as uterine massage and uterotonic medications prove ineffective for PPH caused by uterine atony, placental issues, or coagulopathies, and hysterectomy becomes a potential option, the B-Lynch uterine suture has historically been a common surgical approach [5] . However, the B-Lynch suture is not without limitations: it may fail to achieve hemostasis, and postoperative complications such as uterine infection and tissue necrosis can occur. Therefore, strict criteria for its application are essential.To address these challenges, our hospital has adopted an innovative surgical technique—the uterine mesh-pressure suture—specifically designed for refractory PPH. Over the past decade, 45 patients with refractory PPH underwent this procedure at our institution. Remarkably, all 45 cases successfully preserved the uterus, achieving a 100% success rate. This retrospective study comprehensively reviews these 45 clinical cases, aiming to elucidate the clinical utility of the mesh compressure suture technique and offer a viable treatment option for patients with refractory PPH. The detailed findings are presented below. General Information​ Between January 2014 and December 2023, a total of 36,892 deliveries took place at our hospital. During this period, 1,636 cases of PPH were recorded, resulting in an overall PPH incidence rate of 4.43%. Among these PPH cases, 1,116 patients achieved successful hemostasis following conventional treatments, such as the administration of uterotonic medications, uterine massage, uterine gauze tamponade, uterine artery ligation, or B-Lynch suture. However, 20 patients did not respond to these conventional therapeutic approaches and subsequently underwent hysterectomy as a last resort. In addition, 45 patients were treated with the uterine mesh compressure suture.The use of the uterine mesh compressure suture was approved by the Ethics Committee of our hospital. Before the operation, detailed explanations were provided to the family members of the patients, and written informed consent forms for the surgical procedure were duly signed. These 45 patients who received the mesh compressure suture were categorized into three groups according to their blood loss volume for a more detailed analysis. Significantly, all 45 patients managed to retain their uteri, and the surgical outcomes, including relevant clinical data and patient characteristics, are presented in detail in Table 1. 1.1 Operation Method Instruments: Absorbable suture (size 0), 1/2 arc, 10×24 round needle. 1.1.1 Pre-suture treatment: before suturing, clean the blood in the uterine cavity and abdominal cavity, move the uterus to the abdominal wall outside the incision, massage the uterus sequentially,Inject carboprost tromethamine into the uterine myometrium.Inspect the uterine cavity lining and lower uterine segment. if there is a placental implantation, suture the placental bed with figure-of-eight or interrupted sutures to achieve hemostasis. and Recontour the shape of the uterus. 1.1.2 Uterine mesh compressure suture method: ① the first suture line from the lower edge of the uterine incision 3 cm and the left side of the uterus at 3 cm, through the uterine cavity from the upper edge of the incision 3 cm and the left side of the uterus at 4 cm, longitudinal intervals of 3 cm into the needle, the uterine wall penetration of the longitudinal 3 cm out of the needle, when the suture to the uterine fundus edge of the 4 cm, transverse from the uterus side edge of the 4 cm out of the needle, the suture in the uterus in the plasma membrane surface of the uterine floor across to the posterior wall (avoiding damage to the tubal opening of the corner of the uterus), the suture line in the uterus turned transversely to the right posterior wall out, the rest corresponds to the left side suture.② The entry point of the second suture is 3 cm above the incision on the left side, 3 cm away from the first suture transversely, the direction of the suture from the anterior wall to the posterior wall is the same as that of the first suture, and the exit point corresponds to the entry point on the left side. ③If the distance between the 2nd suture and the uterus is > 9 cm, the 3rd suture is performed, with the entry and exit points 3 cm above the line connecting the entry and exit points of the 2nd suture and 3 cm laterally from the 2nd suture, and the direction of the anterior-to-posterior wall suture line is the same as that of the 2nd suture. 1.1.3 Suture knotting: the 3rd and 2nd sutures are tightened and knotted sequentially and then sutured to close the uterine incision, and the 1st suture is finally knotted in the lower part of the uterine incision. See Fig. 1 and Fig. 2. Results PPHis a serious threat to maternal life and is the leading cause of maternal mortality. PPH is still a worldwide medical problem, and medications or conservative surgical treatments have been used to maximize uterine preservation.B-Lynch suture [ 6 ] is a surgical method that emerged in the late 1990s for the treatment of PPH, and the application of this technique greatly reduces the risk of PPH and hysterectomy, and plays an important role in preserving the reproductive organs of the mother. This technique has greatly reduced the risk of PPH complications and hysterectomy rate, and played an important role in preserving maternal reproductive organs. Many modifications of this technique have emerged: the Cho suture [ 7 ] , with single or multiple square sutures in the lower segment of the uterus; the Hayman suture [ 8 ] , with longitudinal compression sutures to the isthmus at the level of the cervix; the Bhal suture [9] , with double U-shaped sutures to the Body of uterus; the Pereira suture [ 10 ] : multiple longitudinal and transversal compression sutures around the uterus; the Ouahba suture [ 11 ] : compression sutures near the uterine corners and on the upper and lower sides of the uterine incision; the Hackethal suture [ 12 ] : six to sixteen interrupted horizontal sutures from the uterine fundus to the cervix;the Mansoura- VV uterine compression suture [ 13 ] : three V-shaped sutures above the edges of the right and left uterine corners. All of these methods are selective suturing of the uterus at the site of visible or subjectively perceived bleeding, with the following risks:①no compression hemostasis of the uterus at the site of potential or posterior hemorrhage; ②localized sutures turn to aggravate the bleeding at other sites; ③sutures cut the local tissues with compression, leading to local tissue ischemia and the possibility of necrosis of the uterus.In 2006, Treloar [14] reported a case of B-Lynch suture who was admitted to the hospital with bleeding and fever 3 weeks after resection of the uterus, and the uterus was necrotic on histological examination after removal of the uterus, which was analyzed to be ischemia of the uterus due to the local suture. In addition, the passage of the B-Lynch suture through the uterine cavity increases the risk of puerperal infection, and cases of uterine fistula due to poor uterine drainage after B-Lynch suture have been reported in the national literature [ 15 ] .Complications after B-Lynch suture are relatively rare [ 16 ] , but uterine infection and tissue necrosis, leading to hysterectomy are possible, and the surgical indications should be mastered. The B-Lynch suture utilizes a single suture to "strap" the uterus, which distributes stress only on the surface of the uterus, and the suture compresses the uterine cavity. In 2014, our hospital introduced an innovative uterine suturing technique - mesh compression suturing [17] by Dr. Wang Chendi, for the first time for intractable postpartum hemorrhage. Mesh compression suturing is the application of a stress mesh to cover the uterus of PPH, and physically compress the uterus to stop the bleeding with the comprehensive, long-lasting, and balanced compression force of the mesh. In comparison with other uterine suture techniques, the direction of the suture line in uterine mesh pressure suture is basically the same as that of B-Lynch suture, but B-Lynch suture is a suture line in the plasma membrane surface of the uterus to complete a simple circular "binding"; The uterine mesh pressure suture is a two to three longitudinal mattress suture across the anterior and posterior walls of the uterus, tightening the sutures, and constructing a holistic, balanced, and three-dimensional "mesh compressure" system through the synergistic action of the entry and exit points. The "mesh compressure" only acts on the uterine wall, keeping the uterine cavity emptied, preventing poor drainage of the uterine cavity due to external "binding" of the uterus, and decreasing the chance of endometrial wound adhesion and infection of the uterine cavity. The mesh compression suture constructed on the basis of the theory of "stress net" selects the mattress suture [ 18 ] , and establishes a "net pressure" system by distributing the stress between the entry point and the exit point: 1) "net pressure" is comprehensive and balanced, and the stress is distributed between the entry and exit points: (1) the "mesh pressure" is comprehensive and balanced, and the direction of stress contraction is consistent with centripetal uterine regeneration; (2) the "mesh compressure" acts only on the wall of the uterus, and does not constrain the uterine cavity, thus maintaining the natural state of uterine cavity emptying. At the beginning of the new technique [ 19 ] , mesh compression suturing was only used as an alternative to hysterectomy, and then the indication was gradually relaxed. For patients with refractory postpartum hemorrhage, we performed intraoperative simultaneous mesh-pressure suture ± uterine artery ligation; according to the guidelines for postpartum hemorrhage [20] , the hemorrhage volume ≥ 1500 ml was set as the maximum hemorrhage volume for second-degree emergency treatment, and the PPH hemorrhage volume ≥ 1500 ml is currently set as an action alert in the uterine mesh compressure suture treatment strategy, and in case of cesarean section hemorrhage of greater than 1500 ml for a patients, or the actual operation of B-Lynch suture failure patients, We decisively decided to implement the mesh compression suture surgery.They have obtained satisfactory results and successfully preserved the patient's uterus.Based on the actual clinical results of this study, after the completion of uterine mesh compressure suture, the uterine bleeding stopped within 5–10 minutes, with rapid hemostasis, and the earlier the intervention, the lower the risk of intraoperative and postoperative blood transfusions. Postoperative examination results showed that the patient's uterine morphology was well restored, the endometrial line was clear, and hormone levels were not affected. Hysteroscopy revealed normal uterine cavity morphology and normal endometrium. The patients were followed up for a long period of time after the operation, with good recovery of menstruation, and some of them had a repeat pregnancy and successful delivery. The follow-up results showed that the clinical application of mesh compressure suture had good medium and long-term therapeutic effects.making it a valuable addition to the armamentarium for managing PPH. The uterine mesh compressure suture does not require suture feasibility assessment, Once a tendency for the uterine bleeding to stop is detected through the pressure test with both hands by a single person, the suture can be carried out. In practice, it takes about 8–10 minutes to complete the uterine mesh compressure suture, which is easier to master with a basic B-Lynch suture.The following points should be emphasized in uterine mesh compressure suture: ①The first suture crosses the fundus of the uterus twice, both times on the serosal surface and it is kept away from the uterine horns to protect the tubal openings; ② the suture is tightened to maintain sufficient tension, and the force should be sufficient to avoid damaging the serosal surface of uterus. When the uterine mesh compressure suture is completed, the uterus presents a unique "brain gyrus" appearance, which is the visualization of the "mesh compressure" acting on the uterus as a whole. We got confirmation in clinical operation that the uterine mesh compressure suture should be decisively accessed for emergency care in patients with refractory PPH who are unable to stop bleeding despite treatment with uterine massage, pro-contractive drug injections, uterine gauze tamponade, uterine artery ligation and B-Lynch suture. Alternatively, intraoperative cesarean hemorrhage ≥ 1500 ml can be accessed directly and decisively with mesh compressure suture. We believe that mesh pressure suture can be an optional procedure for the treatment of refractory PPH:uterine mesh compressure suture suture has a positive significance for uterine preservation in patients with refractory PPH, and this procedure has no special requirements for medical devices and materials, and it is especially suitable for primary hospitals with limited medical conditions to carry out the application. Declarations Author Contribution Ld:Participation in the concept, design, analysis, writing, revision of the manuscript. Ll : Participation in the concept, design, analysis. W:Participation in the concept, design, revision of the manuscript. Y : revision of the manuscript. References Wang ya-fan, Guo xiao-ming, Wang yan.Research progress in diagnosis and treatment of severe postpartum hemorrhage[J]Chinese Journal of Obstetrics and Gynecology,2024,59(02)：164-167.DOI： 10.3760/cma.j.cn112141-20230819-00056 Zhao yang-yu,Yang yi-ke,Shi hui-feng.Research status and thinking of postpartum hemorrhage in China[J].Chinese Journal of Applied Gynecology and Obstetrics.2024,40,(04)：385-388.DOI:10.19538/j.fk2024040101 Australian Institute of Health and Welfare. Australia's mothers and babies. Data tables: national maternal mortality data collection annual update 2021 [Internet]. 2023 [cited 2024 January 31]. Available from: https://www.aihw.gov.au.． Liu CN, Yu FB, Xu YZ, Li JS, Guan ZH, Sun MN, et al. Prevalence and risk factors of severe postpartum hemorrhage: a retrospective cohort study[J]. BMC Pregnancy Childbirth, 2021,21(1):332. DOI: 10.1186/s12884-021-03818-1 . B-Lynch C, Coker A, Lawal AH, Abu J, Cowen MJ. The B-Lynch surgical technique for the control of nlassive postpartum haemorrhage：an alternative to hystereetomy?five eases reposed[J]．Br J Obstet Gynaecol，1997，104 (3)：372—375．DOI: 10.1111/j.1471-0528.1998.tb09366.x. R Goddard,M Stafford,J R Smith.The B-Lynch surgical technique for the control of massive postpartum haemorrhage: an alternative to hysterectomy? Five cases reported[J]．Br J Obstet Gynaecol,1998 Jan;105(1):126. DOI: 10.1111/j.1471-0528.1998.tb09366.x. Cho JH, Jun HS, Lee CN. Hemostatic suturing technique for uterine bleeding during cesarean delivery. Obstet Gynecol. 2000;96:129–31. DOI: 10.1016/s0029-7844(00)00852-8. Hayman RG, Arulkumaran S, Steer PJ. Uterine compression sutures: surgical management of postpartum hemorrhage. Obstet Gynecol. 2002;99:502–6. DOI: 10.1016/j.ajog.2022.11.1297. Epub 2023 Aug 23. [9].Bhal K，Bhal N，Mulik V，et a1．The uterine compression suture—a valuable approach to control major haemorrhage at lower segment caesarean section[J]．J Obstet Gynaecol，2005，25(1)：10—14．DOI: 10.1080/01443610400022553. Pereira A, Nunes F, Pedroso S, Saraiva J, Retto H, Meirinho M. Compressive uterine sutures to treat postpartum bleeding secondary to uterine atony. Obstet Gynecol. 2005;106:569–72. DOI: 10.1097/01.AOG.0000168434.28222.d3. Ouahba J, Piketty M, Huel C, Azarian M, Feraud O, Luton D, et al. Uterine compression sutures for postpartum bleeding with uterine atony. Br J Obstet Gynaecol. 2007;114:619–22.DOI: 10.1111/j.1471-0528.2007.01272.x. Epub 2007 Mar 13. Hackethal A, Brueggmann D, Oehmke F, Tinneberg HR, Zygmunt MT, Muenstedt K. Uterine compression Usutures in primary postpartum hemorrhage after Cesarean section: fertility preservation with a simple and effective technique. Hum Reprod. 2008;23:74–9. DOI: 10.1093/humrep/dem364. Epub 2007 Nov 17. Abd Elaziz A. El Refaeey, Hosam Abdelfattah , Alaa Mosbah , Anas M. Gamal , Emad Fayla, Waleed Refaie ,el.Is early intervention using Mansoura-VV uterine compression sutures an effective procedure in the management of primary atonic postpartum hemorrhage? : a prospective study.BMC Pregnancy and Childbirth (2017) 17:160 DOI: 10.1186/s12884-017-1349-x. Treloar EJ，Anderson RS，Andrews HS，Bailey JL.Uterine necrosis following B—Lynch suture for prinmry postpartmn haenmrrhage[J]．BJOG，2006，113(4)：4864881.doi: 10.1111/j.1471-0528.2006.00890.x. Cao yu-ping.Abdominouterine fistula after B-Lynch suture: a case report and literature review[J]．Chinese Journal of Obstetrics and Gynecology.20l0,45(3)：208-209．DOI: 10.3760/cma.j.issn.0529-567x.2010.03.011 Rongyao Li,Zheng Fang,Qingqing Zhou,Jing Fu,Ran Meng,Qiaoyun Cai ,el.Postpartum Necrotizing Myositis With Endometrial Prolapse.Obstet Gynecol,2024 May 1;143(5):e136-e139. DOI: 10.1097/AOG.0000000000005556. Epub 2024 Mar 22. Wang Chen-di,Li Li, Lu Xiao-hong Han Qian.Liu Ying,Li Lan el.Clinical Analysis on Chen-di Network Compression Suture for Intractable Postpartum Hemorrhage:45 Cases Report [J]．Chinese Journal of Moern Operative Surgery.2018，22(5)：321—327．DOI: 10．16260／j．cnki．1009—2188．2018．05．001 Wang chen-di ，Yang nei,Xu shi-kang. Two cases of refractory postpartum hemorrhage were treated with Chen-Di network compression suture[J].Chinese Journal of Perinatal Medicine2015,18(9).DOI: 697-699.10.3760/cma.j.issn.1007-9408.2015.09.013 LU Xiao-hong ，LI Jia-qi ，WANG Chen-di.Observation on the application effect of Chen-Di network compression suture in the patients with intractable postpartum hemorrhage and influence for the reproductive system[J]．Shaanxi Medical Journal，2019，48 (8)：1042—1044．DOI：10.3969/j.issn.1000-7377.2019.08.023 Obstetrics Subgroup, Chinese Society of Obstetrics and Gynecology, Chinese Medical Association,Chinese Society of Perinatal Medicine, Chinese Medical Association.Guidelines for prevention and treatment of postpartum hemorrhage (2023)[J]. Chinese Journal of Obstetrics and Gynecology. 2023,58(6):401-409. DOI: 10.3760/cma.j.cn112141-20230223-00084 . Table 1 Table 1 is available in the Supplementary Files section. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6760232","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":462565227,"identity":"dbf0390d-0f7c-4662-99d8-7b5a658ef02c","order_by":0,"name":"Li Dan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzElEQVRIiWNgGAWjYBAC+2b+zw8//mGz42dvIFKLATuDmbFkA1+yZM8BYrXwMxhI8DbIMW64kUCkFnNmhgQDyR1mzAw3H2+8wVBjE01Qi2Uzw4EHhWfS+BhnpxVbMBxLy20gqOcwY4OBBNsxZmbpHDMJxobDxGhhZpDgYfvP2CZ5hkgtBofZGCR429gYeyR4iNQi2czDZixxhi1ZggfolwRi/MLPf4b54YcKNjv744c33vhQY0OEX5AdKZFAinKIFlJ1jIJRMApGwcgAAAFqOdu7GQoSAAAAAElFTkSuQmCC","orcid":"","institution":"The Fifth People's Hospital of Chengdu","correspondingAuthor":true,"prefix":"","firstName":"Li","middleName":"","lastName":"Dan","suffix":""},{"id":462565228,"identity":"dfd8a440-3fee-41f9-8a71-4f3afc1b9e85","order_by":1,"name":"Li Li","email":"","orcid":"","institution":"The Fifth People's Hospital of Chengdu","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Li","suffix":""},{"id":462565229,"identity":"dd5d054c-f7be-48f2-9dce-9bbe0799b8ec","order_by":2,"name":"Xu Yang","email":"","orcid":"","institution":"The Fifth People's Hospital of Chengdu","correspondingAuthor":false,"prefix":"","firstName":"Xu","middleName":"","lastName":"Yang","suffix":""},{"id":462565230,"identity":"50cb6750-e96b-494b-b7be-bb2cdcaf9be1","order_by":3,"name":"Wang Chendi","email":"","orcid":"","institution":"Wenjiang Maternal and Child Health Hospital","correspondingAuthor":false,"prefix":"","firstName":"Wang","middleName":"","lastName":"Chendi","suffix":""}],"badges":[],"createdAt":"2025-05-27 14:08:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6760232/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6760232/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83916383,"identity":"9b3f23da-09af-4078-82d7-cfa9476be54e","added_by":"auto","created_at":"2025-06-04 12:48:16","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":331498,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSchematic diagram of uterine mesh compression suture\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6760232/v1/c01703c3a0c74bb6e692b47e.png"},{"id":83916385,"identity":"5e77610b-2d5a-43a0-b668-b366d46dc71a","added_by":"auto","created_at":"2025-06-04 12:48:16","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":785311,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePost-operative photograph of uterine mesh compression suture\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA: anterior view, arrows show knotting of 2nd suture; B: dorsal view; c: fundal view, left and right arrows show 1st suture crossing the fundus twice at the plasma level, keeping the distance from the uterine horn to protect the tubal opening.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6760232/v1/bf9ff2160f34ee0d4f0ebfbb.png"},{"id":84757587,"identity":"0300889b-8573-4071-a67e-f714b5d9536c","added_by":"auto","created_at":"2025-06-17 05:01:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2413449,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6760232/v1/5bc33341-3c80-4794-b569-232289029ab2.pdf"},{"id":83916386,"identity":"245c7a41-4a8d-484e-af57-0b619d6cd4c0","added_by":"auto","created_at":"2025-06-04 12:48:16","extension":"avi","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":10386888,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"2025051520585101.avi","url":"https://assets-eu.researchsquare.com/files/rs-6760232/v1/b1cfd204cbd8e4c2c85666d3.avi"},{"id":83916381,"identity":"7c14c025-d530-4bd7-8da1-01393dc9bbb2","added_by":"auto","created_at":"2025-06-04 12:48:16","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":17094,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6760232/v1/613ab35300a4182e6c71e14e.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Uterine Mesh Compression Suture: A Modified Therapeutic Approach for Refractory Postpartum Hemorrhage","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePostpartum hemorrhage (PPH) remains the primary cause of maternal morbidity and mortality globally, accounting for 27% of all maternal deaths\u003csup\u003e\u0026nbsp;[1]\u003c/sup\u003e. In 2020, the incidence of severe PPH in China was reported to be 0.96% \u003csup\u003e[2]\u003c/sup\u003e. Alarmingly, even in developed countries, the prevalence of PPH is increasing. For instance, in Australia over the past decade, PPH emerged as the leading cause of maternal mortality, with a rate of 4 deaths per 1 million live births\u003csup\u003e\u0026nbsp;[3]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe four major etiologies of PPH include uterine atony, birth canal trauma, placental abnormalities, and coagulation disorders\u003csup\u003e\u0026nbsp;[4]\u003c/sup\u003e. When traditional treatments such as uterine massage and uterotonic medications prove ineffective for PPH caused by uterine atony, placental issues, or coagulopathies, and hysterectomy becomes a potential option, the B-Lynch uterine suture has historically been a common surgical approach\u003csup\u003e\u0026nbsp;[5]\u003c/sup\u003e. However, the B-Lynch suture is not without limitations: it may fail to achieve hemostasis, and postoperative complications such as uterine infection and tissue necrosis can occur. Therefore, strict criteria for its application are essential.To address these challenges, our hospital has adopted an innovative surgical technique\u0026mdash;the uterine mesh-pressure suture\u0026mdash;specifically designed for refractory PPH. Over the past decade, 45 patients with refractory PPH underwent this procedure at our institution. Remarkably, all 45 cases successfully preserved the uterus, achieving a 100% success rate. This retrospective study comprehensively reviews these 45 clinical cases, aiming to elucidate the clinical utility of the mesh compressure suture technique and offer a viable treatment option for patients with refractory PPH. The detailed findings are presented below.\u003c/p\u003e"},{"header":"General Information​","content":"\u003cp\u003eBetween January 2014 and December 2023, a total of 36,892 deliveries took place at our hospital. During this period, 1,636 cases of PPH were recorded, resulting in an overall PPH incidence rate of 4.43%. Among these PPH cases, 1,116 patients achieved successful hemostasis following conventional treatments, such as the administration of uterotonic medications, uterine massage, uterine gauze tamponade, uterine artery ligation, or B-Lynch suture. However, 20 patients did not respond to these conventional therapeutic approaches and subsequently underwent hysterectomy as a last resort. In addition, 45 patients were treated with the uterine mesh compressure suture.The use of the uterine mesh compressure suture was approved by the Ethics Committee of our hospital. Before the operation, detailed explanations were provided to the family members of the patients, and written informed consent forms for the surgical procedure were duly signed. These 45 patients who received the mesh compressure suture were categorized into three groups according to their blood loss volume for a more detailed analysis. Significantly, all 45 patients managed to retain their uteri, and the surgical outcomes, including relevant clinical data and patient characteristics, are presented in detail in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.1 Operation Method\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInstruments: Absorbable suture (size 0), 1/2 arc, 10\u0026times;24 round needle.\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e1.1.1 Pre-suture treatment: before suturing, clean the blood in the uterine cavity and abdominal cavity, move the uterus to the abdominal wall outside the incision, massage the uterus sequentially,Inject carboprost tromethamine into the uterine myometrium.Inspect the uterine cavity lining and lower uterine segment. if there is a placental implantation, suture the placental bed with figure-of-eight or interrupted sutures to achieve hemostasis. and Recontour the shape of the uterus.\u003cbr\u003e\u003c/span\u003e\u003cspan\u003e1.1.2 Uterine mesh compressure suture method: ① the first suture line from the lower edge of the uterine incision 3 cm and the left side of the uterus at 3 cm, through the uterine cavity from the upper edge of the incision 3 cm and the left side of the uterus at 4 cm, longitudinal intervals of 3 cm into the needle, the uterine wall penetration of the longitudinal 3 cm out of the needle, when the suture to the uterine fundus edge of the 4 cm, transverse from the uterus side edge of the 4 cm out of the needle, the suture in the uterus in the plasma membrane surface of the uterine floor across to the posterior wall (avoiding damage to the tubal opening of the corner of the uterus), the suture line in the uterus turned transversely to the right posterior wall out, the rest corresponds to the left side suture.② The entry point of the second suture is 3 cm above the incision on the left side, 3 cm away from the first suture transversely, the direction of the suture from the anterior wall to the posterior wall is the same as that of the first suture, and the exit point corresponds to the entry point on the left side. ③If the distance between the 2nd suture and the uterus is \u0026gt;\u0026thinsp;9 cm, the 3rd suture is performed, with the entry and exit points 3 cm above the line connecting the entry and exit points of the 2nd suture and 3 cm laterally from the 2nd suture, and the direction of the anterior-to-posterior wall suture line is the same as that of the 2nd suture.\u003cbr\u003e\u003c/span\u003e\u003cspan\u003e1.1.3 Suture knotting: the 3rd and 2nd sutures are tightened and knotted sequentially and then sutured to close the uterine incision, and the 1st suture is finally knotted in the lower part of the uterine incision. See Fig. 1 and Fig. 2.\u003cbr\u003e\u003c/span\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003ePPHis a serious threat to maternal life and is the leading cause of maternal mortality. PPH is still a worldwide medical problem, and medications or conservative surgical treatments have been used to maximize uterine preservation.B-Lynch suture\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e is a surgical method that emerged in the late 1990s for the treatment of PPH, and the application of this technique greatly reduces the risk of PPH and hysterectomy, and plays an important role in preserving the reproductive organs of the mother. This technique has greatly reduced the risk of PPH complications and hysterectomy rate, and played an important role in preserving maternal reproductive organs. Many modifications of this technique have emerged: the Cho suture \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e, with single or multiple square sutures in the lower segment of the uterus; the Hayman suture \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e, with longitudinal compression sutures to the isthmus at the level of the cervix; the Bhal suture \u003csup\u003e[9]\u003c/sup\u003e, with double U-shaped sutures to the Body of uterus; the Pereira suture \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e: multiple longitudinal and transversal compression sutures around the uterus; the Ouahba suture \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e: compression sutures near the uterine corners and on the upper and lower sides of the uterine incision; the Hackethal suture \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e: six to sixteen interrupted horizontal sutures from the uterine fundus to the cervix;the Mansoura- VV uterine compression suture \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e: three V-shaped sutures above the edges of the right and left uterine corners. All of these methods are selective suturing of the uterus at the site of visible or subjectively perceived bleeding, with the following risks:①no compression hemostasis of the uterus at the site of potential or posterior hemorrhage; ②localized sutures turn to aggravate the bleeding at other sites; ③sutures cut the local tissues with compression, leading to local tissue ischemia and the possibility of necrosis of the uterus.In 2006, Treloar \u003csup\u003e[14]\u003c/sup\u003e reported a case of B-Lynch suture who was admitted to the hospital with bleeding and fever 3 weeks after resection of the uterus, and the uterus was necrotic on histological examination after removal of the uterus, which was analyzed to be ischemia of the uterus due to the local suture. In addition, the passage of the B-Lynch suture through the uterine cavity increases the risk of puerperal infection, and cases of uterine fistula due to poor uterine drainage after B-Lynch suture have been reported in the national literature \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e.Complications after B-Lynch suture are relatively rare \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e, but uterine infection and tissue necrosis, leading to hysterectomy are possible, and the surgical indications should be mastered.\u003c/p\u003e\u003cp\u003eThe B-Lynch suture utilizes a single suture to \"strap\" the uterus, which distributes stress only on the surface of the uterus, and the suture compresses the uterine cavity. In 2014, our hospital introduced an innovative uterine suturing technique - mesh compression suturing \u003csup\u003e[17]\u003c/sup\u003e by Dr. Wang Chendi, for the first time for intractable postpartum hemorrhage. Mesh compression suturing is the application of a stress mesh to cover the uterus of PPH, and physically compress the uterus to stop the bleeding with the comprehensive, long-lasting, and balanced compression force of the mesh. In comparison with other uterine suture techniques, the direction of the suture line in uterine mesh pressure suture is basically the same as that of B-Lynch suture, but B-Lynch suture is a suture line in the plasma membrane surface of the uterus to complete a simple circular \"binding\"; The uterine mesh pressure suture is a two to three longitudinal mattress suture across the anterior and posterior walls of the uterus, tightening the sutures, and constructing a holistic, balanced, and three-dimensional \"mesh compressure\" system through the synergistic action of the entry and exit points. The \"mesh compressure\" only acts on the uterine wall, keeping the uterine cavity emptied, preventing poor drainage of the uterine cavity due to external \"binding\" of the uterus, and decreasing the chance of endometrial wound adhesion and infection of the uterine cavity. The mesh compression suture constructed on the basis of the theory of \"stress net\" selects the mattress suture \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e, and establishes a \"net pressure\" system by distributing the stress between the entry point and the exit point: 1) \"net pressure\" is comprehensive and balanced, and the stress is distributed between the entry and exit points: (1) the \"mesh pressure\" is comprehensive and balanced, and the direction of stress contraction is consistent with centripetal uterine regeneration; (2) the \"mesh compressure\" acts only on the wall of the uterus, and does not constrain the uterine cavity, thus maintaining the natural state of uterine cavity emptying.\u003c/p\u003e\u003cp\u003eAt the beginning of the new technique \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e, mesh compression suturing was only used as an alternative to hysterectomy, and then the indication was gradually relaxed. For patients with refractory postpartum hemorrhage, we performed intraoperative simultaneous mesh-pressure suture ± uterine artery ligation; according to the guidelines for postpartum hemorrhage \u003csup\u003e[20]\u003c/sup\u003e, the hemorrhage volume ≥ 1500 ml was set as the maximum hemorrhage volume for second-degree emergency treatment, and the PPH hemorrhage volume ≥ 1500 ml is currently set as an action alert in the uterine mesh compressure suture treatment strategy, and in case of cesarean section hemorrhage of greater than 1500 ml for a patients, or the actual operation of B-Lynch suture failure patients, We decisively decided to implement the mesh compression suture surgery.They have obtained satisfactory results and successfully preserved the patient's uterus.Based on the actual clinical results of this study, after the completion of uterine mesh compressure suture, the uterine bleeding stopped within 5–10 minutes, with rapid hemostasis, and the earlier the intervention, the lower the risk of intraoperative and postoperative blood transfusions. Postoperative examination results showed that the patient's uterine morphology was well restored, the endometrial line was clear, and hormone levels were not affected. Hysteroscopy revealed normal uterine cavity morphology and normal endometrium. The patients were followed up for a long period of time after the operation, with good recovery of menstruation, and some of them had a repeat pregnancy and successful delivery. The follow-up results showed that the clinical application of mesh compressure suture had good medium and long-term therapeutic effects.making it a valuable addition to the armamentarium for managing PPH.\u003c/p\u003e\u003cp\u003eThe uterine mesh compressure suture does not require suture feasibility assessment, Once a tendency for the uterine bleeding to stop is detected through the pressure test with both hands by a single person, the suture can be carried out. In practice, it takes about 8–10 minutes to complete the uterine mesh compressure suture, which is easier to master with a basic B-Lynch suture.The following points should be emphasized in uterine mesh compressure suture: ①The first suture crosses the fundus of the uterus twice, both times on the serosal surface and it is kept away from the uterine horns to protect the tubal openings; ② the suture is tightened to maintain sufficient tension, and the force should be sufficient to avoid damaging the serosal surface of uterus. When the uterine mesh compressure suture is completed, the uterus presents a unique \"brain gyrus\" appearance, which is the visualization of the \"mesh compressure\" acting on the uterus as a whole.\u003c/p\u003e\u003cp\u003eWe got confirmation in clinical operation that the uterine mesh compressure suture should be decisively accessed for emergency care in patients with refractory PPH who are unable to stop bleeding despite treatment with uterine massage, pro-contractive drug injections, uterine gauze tamponade, uterine artery ligation and B-Lynch suture. Alternatively, intraoperative cesarean hemorrhage ≥ 1500 ml can be accessed directly and decisively with mesh compressure suture. We believe that mesh pressure suture can be an optional procedure for the treatment of refractory PPH:uterine mesh compressure suture suture has a positive significance for uterine preservation in patients with refractory PPH, and this procedure has no special requirements for medical devices and materials, and it is especially suitable for primary hospitals with limited medical conditions to carry out the application.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eLd:Participation in the concept, design, analysis, writing, revision of the manuscript. Ll : Participation in the concept, design, analysis. W:Participation in the concept, design, revision of the manuscript. Y : revision of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWang ya-fan, Guo xiao-ming, Wang yan.Research progress in diagnosis and treatment of severe postpartum hemorrhage[J]Chinese Journal of Obstetrics and Gynecology,2024,59(02)：164-167.DOI： 10.3760/cma.j.cn112141-20230819-00056\u003c/li\u003e\n\u003cli\u003eZhao yang-yu,Yang yi-ke,Shi hui-feng.Research status and thinking of postpartum hemorrhage in China[J].Chinese Journal of Applied Gynecology and Obstetrics.2024,40,(04)：385-388.DOI:10.19538/j.fk2024040101\u003c/li\u003e\n\u003cli\u003eAustralian Institute of Health and Welfare. Australia\u0026apos;s mothers and babies. Data tables: national maternal\u003cbr\u003e mortality data collection annual update 2021 [Internet]. 2023 [cited 2024 January 31]. Available from:\u003cbr\u003e https://www.aihw.gov.au.． \u003c/li\u003e\n\u003cli\u003eLiu CN, Yu FB, Xu YZ, Li JS, Guan ZH, Sun MN, et al. Prevalence and risk factors of severe postpartum hemorrhage: a retrospective cohort study[J]. BMC Pregnancy Childbirth, 2021,21(1):332. DOI: 10.1186/s12884-021-03818-1\u0026ensp;.\u003c/li\u003e\n\u003cli\u003eB-Lynch C, Coker A, Lawal AH, Abu J, Cowen MJ. The B-Lynch surgical technique for the control of nlassive postpartum haemorrhage：an alternative to hystereetomy?five eases reposed[J]．Br J Obstet Gynaecol，1997，104 (3)：372\u0026mdash;375．DOI: 10.1111/j.1471-0528.1998.tb09366.x.\u003c/li\u003e\n\u003cli\u003eR Goddard,M Stafford,J R Smith.The B-Lynch surgical technique for the control of massive postpartum haemorrhage: an alternative to hysterectomy? Five cases reported[J]．Br J Obstet Gynaecol,1998 Jan;105(1):126. DOI: 10.1111/j.1471-0528.1998.tb09366.x.\u003c/li\u003e\n\u003cli\u003eCho JH, Jun HS, Lee CN. Hemostatic suturing technique for uterine bleeding during cesarean delivery. Obstet Gynecol. 2000;96:129\u0026ndash;31. DOI: 10.1016/s0029-7844(00)00852-8.\u003c/li\u003e\n\u003cli\u003eHayman RG, Arulkumaran S, Steer PJ. Uterine compression sutures: surgical management of postpartum hemorrhage. Obstet Gynecol. 2002;99:502\u0026ndash;6. DOI: 10.1016/j.ajog.2022.11.1297. Epub 2023 Aug 23.\u003cbr\u003e [9].Bhal K，Bhal N，Mulik V，et a1．The uterine compression suture\u0026mdash;a valuable approach to control \u003c/li\u003e\n\u003cli\u003emajor haemorrhage at lower segment caesarean section[J]．J Obstet Gynaecol，2005，25(1)：10\u0026mdash;14．DOI: 10.1080/01443610400022553.\u003c/li\u003e\n\u003cli\u003ePereira A, Nunes F, Pedroso S, Saraiva J, Retto H, Meirinho M. Compressive uterine sutures to treat postpartum bleeding secondary to uterine atony. Obstet Gynecol. 2005;106:569\u0026ndash;72. DOI: 10.1097/01.AOG.0000168434.28222.d3.\u003c/li\u003e\n\u003cli\u003eOuahba J, Piketty M, Huel C, Azarian M, Feraud O, Luton D, et al. Uterine compression sutures for postpartum bleeding with uterine atony. Br J Obstet Gynaecol. 2007;114:619\u0026ndash;22.DOI: 10.1111/j.1471-0528.2007.01272.x. Epub 2007 Mar 13.\u003c/li\u003e\n\u003cli\u003eHackethal A, Brueggmann D, Oehmke F, Tinneberg HR, Zygmunt MT, Muenstedt K. Uterine compression Usutures in primary postpartum hemorrhage after Cesarean section: fertility preservation with a simple and effective technique. Hum Reprod. 2008;23:74\u0026ndash;9. DOI: 10.1093/humrep/dem364. Epub 2007 Nov 17.\u003c/li\u003e\n\u003cli\u003eAbd Elaziz A. El Refaeey, Hosam Abdelfattah , Alaa Mosbah , Anas M. Gamal , Emad Fayla, Waleed Refaie ,el.Is early intervention using Mansoura-VV uterine compression sutures an effective procedure in the management of primary atonic postpartum hemorrhage? : a prospective study.BMC Pregnancy and Childbirth (2017) 17:160 DOI: 10.1186/s12884-017-1349-x.\u003c/li\u003e\n\u003cli\u003eTreloar EJ，Anderson RS，Andrews HS，Bailey JL.Uterine necrosis following B\u0026mdash;Lynch suture for prinmry postpartmn haenmrrhage[J]．BJOG，2006，113(4)：4864881.doi: 10.1111/j.1471-0528.2006.00890.x. \u003c/li\u003e\n\u003cli\u003eCao yu-ping.Abdominouterine fistula after B-Lynch suture: a case report and literature review[J]．Chinese Journal of Obstetrics and Gynecology.20l0,45(3)：208-209．DOI: 10.3760/cma.j.issn.0529-567x.2010.03.011\u003c/li\u003e\n\u003cli\u003eRongyao Li,Zheng Fang,Qingqing Zhou,Jing Fu,Ran Meng,Qiaoyun Cai ,el.Postpartum Necrotizing Myositis With Endometrial Prolapse.Obstet Gynecol,2024 May 1;143(5):e136-e139. DOI: 10.1097/AOG.0000000000005556. Epub 2024 Mar 22.\u003c/li\u003e\n\u003cli\u003eWang Chen-di,Li Li, Lu Xiao-hong Han Qian.Liu Ying,Li Lan el.Clinical Analysis on Chen-di Network Compression Suture for Intractable Postpartum Hemorrhage:45 Cases Report [J]．Chinese Journal of Moern Operative Surgery.2018，22(5)：321\u0026mdash;327．DOI: 10．16260／j．cnki．1009\u0026mdash;2188．2018．05．001\u003c/li\u003e\n\u003cli\u003eWang chen-di ，Yang nei,Xu shi-kang. Two cases of refractory postpartum hemorrhage were treated with Chen-Di network compression suture[J].Chinese Journal of Perinatal Medicine2015,18(9).DOI: 697-699.10.3760/cma.j.issn.1007-9408.2015.09.013\u003c/li\u003e\n\u003cli\u003eLU Xiao-hong ，LI Jia-qi ，WANG Chen-di.Observation on the application effect of Chen-Di network compression suture in the patients with intractable postpartum hemorrhage and influence for the reproductive system[J]．Shaanxi Medical Journal，2019，48 (8)：1042\u0026mdash;1044．DOI：10.3969/j.issn.1000-7377.2019.08.023 \u003c/li\u003e\n\u003cli\u003eObstetrics Subgroup, Chinese Society of Obstetrics and Gynecology, Chinese Medical Association,Chinese Society of Perinatal Medicine, Chinese Medical Association.Guidelines for prevention and treatment of postpartum hemorrhage (2023)[J]. Chinese Journal of Obstetrics and Gynecology. 2023,58(6):401-409. DOI: 10.3760/cma.j.cn112141-20230223-00084\u0026ensp;.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 1","content":"\u003cp\u003eTable 1 is available in the Supplementary Files section.\u003c/p\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Refractory postpartum hemorrhage, Emergency obstetric care, Uterine mesh compression suture, Surgical efficacy, Indications","lastPublishedDoi":"10.21203/rs.3.rs-6760232/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6760232/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: To investigate the application value of a novel suture technique—uterine mesh compression suture (UMCS)—in the management of refractory postpartum hemorrhage (PPH).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A retrospective analysis was performed on 45 patients with refractory PPH who underwent UMCS, evaluating the surgical efficacy and safety. Clinical data, including hemostatic effect, postoperative complications, reproductive function outcomes, and long-term follow-up results, were systematically analyzed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: In all cases, active uterine bleeding ceased within 5–10 minutes after UMCS. Cumulative vaginal blood loss was \u0026lt;20 mL within 2 hours postoperatively, confirming effective hemostasis. Magnetic resonance imaging (MRI) on day 4 revealed no intrauterine effusion; Postoperative hormone assays showed all values within normal ranges at 5 days postoperatively; At 42 days postoperatively, both ultrasound and MRI demonstrated normal uterine structure without abnormalities. Hysteroscopic examination at 6 months showed no intrauterine adhesions, with clear patency of fallopian tube ostia. During follow-up, 45 patients resumed normal menstruation 1–2 months after stopping breastfeeding. Ten patients achieved subsequent pregnancy, including 4 who underwent repeat cesarean delivery and 6 who terminated pregnancy via induced abortion, with no reported complications related to the suture technique.\u003c/p\u003e\n\u003cp\u003eConclusion: UMCS effectively controls PPH caused by uterine atony. This technique is recommended for patients with refractory PPH due to uterine atony who fail traditional hemostatic measures, or for cases of intraoperative bleeding ≥1500 mL during cesarean section, where UMCS can be performed directly as a first-line intervention.\u003c/p\u003e","manuscriptTitle":"Uterine Mesh Compression Suture: A Modified Therapeutic Approach for Refractory Postpartum Hemorrhage","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-04 12:48:11","doi":"10.21203/rs.3.rs-6760232/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3fbbb876-9b60-4536-8d93-98cb18f43d23","owner":[],"postedDate":"June 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":49115466,"name":"Health sciences/Diseases"},{"id":49115467,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2025-06-17T04:53:43+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-04 12:48:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6760232","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6760232","identity":"rs-6760232","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}