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

Yanyan Bai, L L Guo, Fuling Wang, Kehua Zhu
In: BMC Pregnancy and Childbirth · 2026 · doi:10.1186/s12884-026-09457-8 · PMID:42288755 · W7164645028
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This case report describes a modified quadruple uterine belt suture technique that achieved successful hemostasis and uterus preservation in a patient experiencing severe postpartum hemorrhage during cesarean section due to complex placental and uterine abnormalities.

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This case report describes a 40+2-week pregnant patient who developed severe postpartum hemorrhage during cesarean section, with blood loss up to 2,500 mL, in the context of gestational diabetes mellitus and prenatal fever. The hemorrhage was attributed to complex placental pathology and uterine conditions, including complete dense adhesion between placenta and membranes, partial placental implantation on the posterior uterine wall, extensive intrauterine adhesions with pseudocyst formation, and uterine atony; multiple conventional hemostatic interventions (including uterotonic agents, arterial ligation, local figure-of-eight sutures, and intrauterine packing) failed. Emergency modified quadruple uterine belt (dorsal) suturing was then used and reportedly achieved rapid hemostasis with successful uterine preservation, followed by multidisciplinary postoperative infection control and thrombosis/anemia/albumin management, with favorable 3-month follow-up imaging. Limitations include that evidence is limited to a single case and the report’s conclusions are not generalizable beyond this scenario. The paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

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.
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Abstract

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. Similar content being viewed by others Abbreviations - CRP: - Reactive protein - PCT: - Procalcitonin

Acknowledgements

We would like to thank the patient and the patient’s parents for their trust and openness. Funding Not applicable. Author information Authors and Affiliations Corresponding authors Ethics declarations Ethics approval and consent to participate This case report was deemed exempt by the Ethics Committee of the Affiliated Hospital of Jining Medical University. Consent for publication Written informed consent was obtained from the patient to publish this case report. Competing interests The authors declare no competing interests. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. About this article Cite this article Bai, Y., Guo, L., Wang, F. et al. Case report on resistant postpartum hemorrhage during cesarean section treated with a modified quadruple uterine belt suture technique for uterus preservation. BMC Pregnancy Childbirth (2026). https://doi.org/10.1186/s12884-026-09457-8 Received: Accepted: Published: DOI: https://doi.org/10.1186/s12884-026-09457-8

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