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Quilting Sutures in Postpartum Hemorrhage, Management Approach of Intractable Uterine Atony Case Report at MOI Teaching and Referral Hospital, Eldoret Kenya

Moseti G, Mogeni R and Abdalla H

Pregnancies that are term or are over 20 weeks of gestation are at risk of postpartum hemorrhage (PPH) and its consequences. In developed countries there has been a decrease in maternal mortality rates however post-partum hemorrhage remains among the major cause of morbidity and mortality in the developing and low resource setting countries. In the control of bleeding in PPH, compression sutures are used such as B-lynch suture, recent studies have advocated for a fertility sparing procedures that do not entail hysterectomy where compression sutures are used to achieve hemostasis. One such compression suture is known as quilting sutures, where the anterior and posterior walls are compressed together using multiple ‘U’ shaped stiches from top to bottom of the myometrium This report is of a 20-year-old primigravida presenting in the 2nd trimester at 25 weeks gestation in active phase of labour, whose delivery complicated to a post-partum haemorrhage due to atony. The case was managed as per MTRH treatment protocol for PPH initially with uterotonic. Intractable PPH resulted in use of quilting sutures which spontaneously achieve a uterine tamponade that stopped the bleeding. Post-natal period was uneventful and patient regained her regular menses. Use of quilting suture as a fertility sparing method of compression sutures is beneficial in the reduction of morbidity and mortality in patients with PPH.