Comment on “Alternate Sequential Suture Tightening: A Novel Technique for Uncontrolled Postpartum Hemorrhage”

Figure 1

Schematic presentation of the Matsubara-Yano (MY) uterine compression suture (a) and possible drawbacks of the Ghosh suture (b, c). (a) The MY suture consists of two (or three) longitudinal transfixation sutures and two transverse sutures. Upper insets indicate how the first longitudinal transfixation suture is placed. Then, the transverse sutures are placed lateral to the longitudinal suture (arrow), thereby preventing the thread from sliding out (off). (b) Ghosh suture is a modification of Hayman suture (upper left insets). If the knot of a Ghosh suture is too tight, it may destroy the caudal insertion site (arrow), or the lower uterine segment, which is thin and weak. Upper right inset shows the sagittal view. (c) In the Ghosh suture, similar to the B-Lynch or Hayman suture, sutures may “slide out (off)” from the uterine fundus (left), thus yielding insufficient compression. If the knot is too tight, the chance of “sliding out” may be higher, since there may be no room for the suture to move. Even if it does not slide out, the thread may embed in the uterus (right), leading to uterine ischemia.